| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,041 |
7,230 |
$1.39M |
| D1351 |
Sealant - per tooth |
39,223 |
10,420 |
$1.07M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,113 |
7,106 |
$936K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,388 |
5,345 |
$750K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,870 |
1,115 |
$702K |
| D1120 |
Prophylaxis - child |
17,570 |
17,447 |
$635K |
| D0230 |
Intraoral - periapical each additional radiographic image |
44,431 |
18,469 |
$494K |
| D0120 |
Periodic oral evaluation - established patient |
17,012 |
16,909 |
$485K |
| D0210 |
Intraoral - complete series of radiographic images |
5,503 |
5,439 |
$374K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,861 |
23,692 |
$346K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,676 |
12,249 |
$338K |
| D1110 |
Prophylaxis - adult |
5,811 |
5,765 |
$314K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,593 |
7,506 |
$260K |
| D0220 |
Intraoral - periapical first radiographic image |
19,759 |
19,543 |
$243K |
| D0272 |
Bitewings - two radiographic images |
7,830 |
7,773 |
$180K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,113 |
634 |
$172K |
| D0274 |
Bitewings - four radiographic images |
4,961 |
4,925 |
$168K |
| D7140 |
Extraction, erupted tooth or exposed root |
263 |
147 |
$16K |
| D2934 |
|
90 |
26 |
$13K |
| D2330 |
|
131 |
88 |
$10K |
| D2332 |
|
47 |
26 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
220 |
217 |
$4K |
| D7111 |
|
77 |
52 |
$883.19 |
| D0160 |
|
13 |
13 |
$179.40 |
| D1330 |
|
12 |
12 |
$135.25 |
| D0603 |
|
30,946 |
30,706 |
$0.00 |
| D0602 |
|
15 |
15 |
$0.00 |