| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23,138 |
8,741 |
$2.28M |
| D0145 |
Oral evaluation for a patient under three years of age |
6,337 |
6,328 |
$894K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,912 |
4,282 |
$686K |
| D1120 |
Prophylaxis - child |
14,505 |
14,424 |
$522K |
| D1351 |
Sealant - per tooth |
16,446 |
5,303 |
$444K |
| D0120 |
Periodic oral evaluation - established patient |
15,464 |
15,385 |
$441K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,677 |
13,451 |
$364K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,923 |
19,807 |
$287K |
| D0210 |
Intraoral - complete series of radiographic images |
3,935 |
3,919 |
$267K |
| D1110 |
Prophylaxis - adult |
4,167 |
4,141 |
$224K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,333 |
14,317 |
$218K |
| D0220 |
Intraoral - periapical first radiographic image |
15,549 |
15,439 |
$192K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,256 |
617 |
$181K |
| D0274 |
Bitewings - four radiographic images |
5,257 |
5,214 |
$178K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,321 |
4,292 |
$149K |
| D0272 |
Bitewings - two radiographic images |
6,206 |
6,176 |
$143K |
| D2330 |
|
1,272 |
790 |
$95K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
726 |
414 |
$74K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
484 |
256 |
$40K |
| D2332 |
|
63 |
40 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
97 |
73 |
$4K |
| D2331 |
|
44 |
26 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
181 |
180 |
$3K |
| D7111 |
|
15 |
12 |
$172.05 |
| D0603 |
|
28,752 |
28,601 |
$0.00 |