| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,363 |
6,763 |
$1.42M |
| D0120 |
Periodic oral evaluation - established patient |
18,986 |
18,861 |
$540K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,853 |
3,831 |
$539K |
| D1351 |
Sealant - per tooth |
18,535 |
5,877 |
$504K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,024 |
3,739 |
$465K |
| D1120 |
Prophylaxis - child |
12,869 |
12,782 |
$453K |
| D0230 |
Intraoral - periapical each additional radiographic image |
38,096 |
16,611 |
$421K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,405 |
633 |
$345K |
| D1110 |
Prophylaxis - adult |
6,292 |
6,242 |
$334K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,682 |
19,539 |
$279K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,552 |
8,335 |
$223K |
| D0274 |
Bitewings - four radiographic images |
6,575 |
6,530 |
$223K |
| D0220 |
Intraoral - periapical first radiographic image |
17,299 |
17,162 |
$213K |
| D0210 |
Intraoral - complete series of radiographic images |
2,838 |
2,815 |
$195K |
| D0272 |
Bitewings - two radiographic images |
7,335 |
7,284 |
$169K |
| D9248 |
|
1,292 |
1,268 |
$149K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,093 |
364 |
$89K |
| D0350 |
|
3,851 |
3,810 |
$63K |
| D2330 |
|
673 |
482 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
756 |
738 |
$26K |
| D7240 |
Removal of impacted tooth - completely bony |
41 |
15 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
451 |
447 |
$8K |
| D1330 |
|
292 |
291 |
$3K |
| D7111 |
|
38 |
27 |
$435.86 |
| D0603 |
|
25,034 |
24,872 |
$0.00 |