| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,029 |
3,196 |
$585K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,689 |
3,670 |
$518K |
| D1120 |
Prophylaxis - child |
7,110 |
7,081 |
$257K |
| D1351 |
Sealant - per tooth |
8,914 |
2,512 |
$240K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,925 |
1,956 |
$223K |
| D0120 |
Periodic oral evaluation - established patient |
7,675 |
7,643 |
$219K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,614 |
7,368 |
$207K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,070 |
5,901 |
$157K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,252 |
9,215 |
$134K |
| D0210 |
Intraoral - complete series of radiographic images |
1,603 |
1,595 |
$107K |
| D0220 |
Intraoral - periapical first radiographic image |
8,081 |
7,985 |
$98K |
| D1110 |
Prophylaxis - adult |
1,787 |
1,774 |
$95K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
542 |
317 |
$77K |
| D0272 |
Bitewings - two radiographic images |
2,481 |
2,476 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,553 |
1,542 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,459 |
1,446 |
$50K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
185 |
134 |
$15K |
| D9248 |
|
94 |
93 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
408 |
397 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
119 |
91 |
$6K |
| D0160 |
|
181 |
178 |
$3K |
| D1330 |
|
184 |
182 |
$2K |
| D0602 |
|
1,514 |
1,509 |
$0.00 |
| D0603 |
|
11,839 |
11,764 |
$0.00 |