| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,297 |
5,773 |
$1.41M |
| D0145 |
Oral evaluation for a patient under three years of age |
6,811 |
6,543 |
$909K |
| D0120 |
Periodic oral evaluation - established patient |
26,347 |
25,635 |
$731K |
| D1120 |
Prophylaxis - child |
18,348 |
17,753 |
$639K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,308 |
1,401 |
$573K |
| D1351 |
Sealant - per tooth |
20,560 |
5,105 |
$520K |
| D1110 |
Prophylaxis - adult |
9,255 |
9,012 |
$484K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,993 |
2,727 |
$427K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,682 |
26,811 |
$389K |
| D0272 |
Bitewings - two radiographic images |
16,819 |
16,300 |
$356K |
| D0220 |
Intraoral - periapical first radiographic image |
28,986 |
27,886 |
$327K |
| D9248 |
|
2,706 |
2,548 |
$304K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,639 |
26,709 |
$288K |
| D0274 |
Bitewings - four radiographic images |
9,097 |
8,853 |
$281K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,637 |
967 |
$197K |
| D7240 |
Removal of impacted tooth - completely bony |
496 |
152 |
$136K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
997 |
672 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
1,283 |
1,283 |
$82K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,594 |
2,459 |
$67K |
| D0330 |
Panoramic radiographic image |
4,523 |
4,373 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,961 |
1,807 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
991 |
864 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
500 |
330 |
$24K |
| D9243 |
|
561 |
199 |
$19K |
| D9239 |
|
209 |
198 |
$11K |
| D1330 |
|
424 |
418 |
$1K |
| D9612 |
|
30 |
29 |
$1K |
| D0603 |
|
34,782 |
33,646 |
$0.24 |
| D9986 |
|
82 |
80 |
$0.00 |