| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21,979 |
6,551 |
$2.15M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14,355 |
4,936 |
$1.08M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,493 |
1,822 |
$925K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,033 |
1,518 |
$308K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,150 |
8,940 |
$307K |
| D1120 |
Prophylaxis - child |
7,337 |
7,201 |
$258K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,928 |
7,719 |
$204K |
| D1110 |
Prophylaxis - adult |
3,435 |
3,360 |
$180K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,664 |
10,344 |
$165K |
| D1351 |
Sealant - per tooth |
6,517 |
1,773 |
$157K |
| D1206 |
Topical application of fluoride varnish |
10,755 |
10,543 |
$151K |
| D0272 |
Bitewings - two radiographic images |
4,712 |
4,605 |
$104K |
| D0274 |
Bitewings - four radiographic images |
4,088 |
4,010 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
10,639 |
10,398 |
$103K |
| D2330 |
|
1,283 |
720 |
$93K |
| D0145 |
Oral evaluation for a patient under three years of age |
653 |
635 |
$88K |
| D2332 |
|
629 |
362 |
$79K |
| D0210 |
Intraoral - complete series of radiographic images |
867 |
867 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,672 |
1,646 |
$47K |
| D2331 |
|
490 |
306 |
$46K |
| D0330 |
Panoramic radiographic image |
2,101 |
2,077 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
653 |
380 |
$32K |
| D0350 |
|
6,005 |
5,873 |
$29K |
| D2335 |
|
108 |
71 |
$17K |
| D3240 |
|
141 |
85 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
44 |
28 |
$4K |
| D9248 |
|
30 |
30 |
$3K |
| D2394 |
|
20 |
12 |
$3K |
| D7111 |
|
159 |
108 |
$2K |
| D0460 |
|
78 |
78 |
$869.75 |
| D1330 |
|
196 |
193 |
$526.75 |
| D0603 |
|
11,339 |
11,149 |
$0.00 |
| D0602 |
|
159 |
156 |
$0.00 |