| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24,319 |
7,157 |
$2.35M |
| D0145 |
Oral evaluation for a patient under three years of age |
4,765 |
4,716 |
$652K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,014 |
3,321 |
$601K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,393 |
755 |
$492K |
| D1120 |
Prophylaxis - child |
10,581 |
10,484 |
$375K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,665 |
11,493 |
$344K |
| D1351 |
Sealant - per tooth |
13,054 |
3,618 |
$340K |
| D0120 |
Periodic oral evaluation - established patient |
10,799 |
10,696 |
$305K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,660 |
8,383 |
$215K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,394 |
14,252 |
$205K |
| D0210 |
Intraoral - complete series of radiographic images |
2,886 |
2,835 |
$188K |
| D1110 |
Prophylaxis - adult |
3,418 |
3,368 |
$180K |
| D0274 |
Bitewings - four radiographic images |
4,651 |
4,596 |
$157K |
| D0220 |
Intraoral - periapical first radiographic image |
12,896 |
12,632 |
$154K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,465 |
4,390 |
$151K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,756 |
481 |
$144K |
| D9248 |
|
884 |
879 |
$100K |
| D2330 |
|
1,052 |
406 |
$78K |
| D0272 |
Bitewings - two radiographic images |
3,332 |
3,300 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
2,060 |
2,021 |
$29K |
| D2934 |
|
129 |
38 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
148 |
86 |
$15K |
| D0350 |
|
974 |
967 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
221 |
130 |
$7K |
| D1330 |
|
405 |
400 |
$4K |
| D1352 |
|
16 |
14 |
$561.60 |
| D0603 |
|
21,260 |
21,028 |
$0.00 |