| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,194 |
1,213 |
$295K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,713 |
2,283 |
$88K |
| D1120 |
Prophylaxis - child |
2,540 |
2,471 |
$85K |
| D1351 |
Sealant - per tooth |
3,240 |
864 |
$83K |
| D0145 |
Oral evaluation for a patient under three years of age |
513 |
503 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,064 |
2,004 |
$55K |
| D9248 |
|
408 |
390 |
$45K |
| D1206 |
Topical application of fluoride varnish |
3,179 |
3,091 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
265 |
99 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
527 |
509 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,329 |
1,199 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,708 |
2,585 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
913 |
874 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
260 |
145 |
$18K |
| D1110 |
Prophylaxis - adult |
284 |
277 |
$14K |
| D0272 |
Bitewings - two radiographic images |
525 |
515 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
70 |
39 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
74 |
29 |
$5K |
| D2332 |
|
18 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
52 |
51 |
$1K |
| D9430 |
|
14 |
12 |
$157.63 |
| D0603 |
|
4,400 |
4,310 |
$0.00 |
| D9986 |
|
111 |
111 |
$0.00 |