| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,623 |
5,394 |
$1.15M |
| D0120 |
Periodic oral evaluation - established patient |
17,774 |
17,572 |
$497K |
| D1120 |
Prophylaxis - child |
12,490 |
12,319 |
$446K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,208 |
3,145 |
$435K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,579 |
3,245 |
$426K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,142 |
19,581 |
$384K |
| D0274 |
Bitewings - four radiographic images |
10,616 |
10,495 |
$344K |
| D1110 |
Prophylaxis - adult |
6,320 |
6,255 |
$336K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,184 |
18,934 |
$275K |
| D1351 |
Sealant - per tooth |
9,919 |
2,383 |
$255K |
| D0220 |
Intraoral - periapical first radiographic image |
20,636 |
20,300 |
$245K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,538 |
8,013 |
$219K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,020 |
310 |
$143K |
| D0272 |
Bitewings - two radiographic images |
4,609 |
4,523 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,159 |
1,133 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
337 |
186 |
$32K |
| D9248 |
|
258 |
240 |
$28K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
99 |
26 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
278 |
265 |
$5K |
| D0160 |
|
302 |
285 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
72 |
48 |
$4K |
| D2331 |
|
28 |
14 |
$3K |
| D0330 |
Panoramic radiographic image |
141 |
138 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$847.68 |
| D7111 |
|
59 |
40 |
$653.79 |
| D0603 |
|
25,288 |
24,792 |
$76.15 |