| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,066 |
6,186 |
$1.44M |
| D0120 |
Periodic oral evaluation - established patient |
21,817 |
21,324 |
$610K |
| D1120 |
Prophylaxis - child |
14,938 |
14,572 |
$528K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,746 |
3,668 |
$516K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,536 |
3,566 |
$488K |
| D1351 |
Sealant - per tooth |
16,357 |
3,810 |
$437K |
| D1110 |
Prophylaxis - adult |
7,446 |
7,276 |
$395K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,419 |
1,197 |
$339K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,794 |
22,247 |
$323K |
| D0274 |
Bitewings - four radiographic images |
8,582 |
8,363 |
$272K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,997 |
8,400 |
$230K |
| D0220 |
Intraoral - periapical first radiographic image |
19,171 |
18,681 |
$224K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,545 |
18,057 |
$198K |
| D0210 |
Intraoral - complete series of radiographic images |
2,852 |
2,815 |
$193K |
| D0272 |
Bitewings - two radiographic images |
8,780 |
8,563 |
$193K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
687 |
356 |
$55K |
| D7240 |
Removal of impacted tooth - completely bony |
189 |
79 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
373 |
223 |
$34K |
| D0330 |
Panoramic radiographic image |
1,660 |
1,594 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
532 |
499 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
108 |
107 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
27 |
$2K |
| D2331 |
|
18 |
13 |
$2K |
| D7111 |
|
134 |
92 |
$1K |
| D2330 |
|
17 |
13 |
$1K |
| D0602 |
|
12,610 |
12,390 |
$0.00 |
| D0601 |
|
1,539 |
1,487 |
$0.00 |
| D0603 |
|
12,550 |
12,254 |
$0.00 |