| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,865 |
1,594 |
$364K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,491 |
2,425 |
$325K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,334 |
1,538 |
$244K |
| D1351 |
Sealant - per tooth |
9,130 |
1,986 |
$234K |
| D0120 |
Periodic oral evaluation - established patient |
8,793 |
8,400 |
$229K |
| D1120 |
Prophylaxis - child |
6,327 |
6,099 |
$209K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,911 |
8,532 |
$203K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,231 |
407 |
$166K |
| D1110 |
Prophylaxis - adult |
3,407 |
3,218 |
$163K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,438 |
9,026 |
$125K |
| D0274 |
Bitewings - four radiographic images |
3,919 |
3,756 |
$112K |
| D0220 |
Intraoral - periapical first radiographic image |
9,844 |
9,326 |
$103K |
| D0330 |
Panoramic radiographic image |
1,792 |
1,643 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,651 |
1,520 |
$49K |
| D0272 |
Bitewings - two radiographic images |
2,645 |
2,519 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
465 |
460 |
$30K |
| D9248 |
|
340 |
319 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
170 |
98 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
429 |
412 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
183 |
179 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15 |
12 |
$1K |
| D0270 |
|
14 |
13 |
$49.00 |
| D0603 |
|
13,132 |
12,728 |
$0.00 |