| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,099 |
3,170 |
$934K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,066 |
2,404 |
$523K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,139 |
673 |
$440K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,413 |
2,384 |
$330K |
| D1120 |
Prophylaxis - child |
6,499 |
6,432 |
$225K |
| D0120 |
Periodic oral evaluation - established patient |
7,662 |
7,600 |
$214K |
| D1110 |
Prophylaxis - adult |
2,520 |
2,502 |
$130K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,080 |
8,989 |
$126K |
| D1351 |
Sealant - per tooth |
4,901 |
1,466 |
$123K |
| D0274 |
Bitewings - four radiographic images |
3,604 |
3,571 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
8,120 |
8,030 |
$98K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,025 |
7,727 |
$89K |
| D0210 |
Intraoral - complete series of radiographic images |
1,191 |
1,172 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,181 |
2,148 |
$73K |
| D0272 |
Bitewings - two radiographic images |
3,063 |
3,022 |
$69K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
775 |
250 |
$59K |
| D9248 |
|
460 |
459 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
410 |
214 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
950 |
922 |
$24K |
| D2330 |
|
203 |
132 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
238 |
119 |
$13K |
| D0350 |
|
88 |
88 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
64 |
63 |
$1K |
| D1999 |
|
626 |
590 |
$0.00 |
| D0603 |
|
12,948 |
12,793 |
$0.00 |