| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,984 |
4,148 |
$1.28M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,533 |
1,225 |
$911K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,255 |
2,566 |
$598K |
| D0120 |
Periodic oral evaluation - established patient |
15,216 |
15,059 |
$419K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,960 |
2,869 |
$396K |
| D1120 |
Prophylaxis - child |
10,998 |
10,870 |
$375K |
| D1110 |
Prophylaxis - adult |
5,278 |
5,223 |
$269K |
| D0274 |
Bitewings - four radiographic images |
7,955 |
7,877 |
$263K |
| D1351 |
Sealant - per tooth |
10,364 |
2,415 |
$263K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,811 |
16,613 |
$230K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,897 |
15,212 |
$206K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,591 |
692 |
$197K |
| D0220 |
Intraoral - periapical first radiographic image |
15,795 |
15,573 |
$189K |
| D9248 |
|
1,059 |
1,047 |
$124K |
| D0272 |
Bitewings - two radiographic images |
4,911 |
4,837 |
$109K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,479 |
3,315 |
$89K |
| D7240 |
Removal of impacted tooth - completely bony |
217 |
73 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,526 |
1,494 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
432 |
417 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
257 |
129 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
502 |
292 |
$25K |
| D0350 |
|
183 |
181 |
$3K |
| D2330 |
|
36 |
15 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
75 |
72 |
$1K |
| D7111 |
|
17 |
12 |
$172.05 |
| D1999 |
|
1,518 |
1,447 |
$0.00 |
| D0603 |
|
21,564 |
21,211 |
$0.00 |