| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,056 |
1,908 |
$407K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,203 |
765 |
$318K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,173 |
2,156 |
$303K |
| D1351 |
Sealant - per tooth |
8,789 |
2,607 |
$239K |
| D1120 |
Prophylaxis - child |
6,259 |
6,206 |
$221K |
| D0120 |
Periodic oral evaluation - established patient |
7,197 |
7,142 |
$204K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,638 |
1,586 |
$201K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,149 |
8,964 |
$157K |
| D1110 |
Prophylaxis - adult |
2,718 |
2,689 |
$145K |
| D0272 |
Bitewings - two radiographic images |
6,181 |
6,137 |
$142K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,012 |
8,935 |
$130K |
| D0220 |
Intraoral - periapical first radiographic image |
9,342 |
9,227 |
$112K |
| D0274 |
Bitewings - four radiographic images |
2,570 |
2,540 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,681 |
1,655 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,905 |
1,777 |
$50K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
219 |
93 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
108 |
108 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
86 |
58 |
$3K |
| D0330 |
Panoramic radiographic image |
478 |
473 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
78 |
$1K |
| D0601 |
|
2,216 |
2,202 |
$0.00 |
| D0603 |
|
3,271 |
3,241 |
$0.00 |
| D0602 |
|
5,568 |
5,542 |
$0.00 |