| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,272 |
4,697 |
$1.15M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,144 |
1,191 |
$852K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,685 |
4,079 |
$791K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,655 |
4,574 |
$639K |
| D0120 |
Periodic oral evaluation - established patient |
15,519 |
15,332 |
$434K |
| D1120 |
Prophylaxis - child |
12,234 |
12,077 |
$423K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,728 |
884 |
$279K |
| D1110 |
Prophylaxis - adult |
5,257 |
5,201 |
$275K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,911 |
17,674 |
$249K |
| D0210 |
Intraoral - complete series of radiographic images |
3,718 |
3,664 |
$243K |
| D0274 |
Bitewings - four radiographic images |
6,464 |
6,387 |
$214K |
| D1351 |
Sealant - per tooth |
7,604 |
2,593 |
$198K |
| D0220 |
Intraoral - periapical first radiographic image |
14,404 |
14,184 |
$175K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,675 |
13,518 |
$173K |
| D9248 |
|
1,259 |
1,239 |
$147K |
| D0272 |
Bitewings - two radiographic images |
5,617 |
5,523 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,417 |
2,383 |
$80K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,151 |
538 |
$59K |
| D2330 |
|
347 |
197 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
993 |
937 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
143 |
84 |
$12K |
| D0350 |
|
410 |
409 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
270 |
262 |
$5K |
| D2331 |
|
15 |
12 |
$1K |
| D1999 |
|
1,790 |
1,698 |
$0.00 |
| D0603 |
|
24,725 |
24,309 |
$0.00 |