| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,988 |
5,044 |
$1.71M |
| D1351 |
Sealant - per tooth |
27,967 |
6,196 |
$689K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,753 |
4,666 |
$650K |
| D0120 |
Periodic oral evaluation - established patient |
20,487 |
19,968 |
$563K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,537 |
2,692 |
$556K |
| D1120 |
Prophylaxis - child |
13,984 |
13,638 |
$487K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,445 |
951 |
$467K |
| D1110 |
Prophylaxis - adult |
7,309 |
7,129 |
$376K |
| D0274 |
Bitewings - four radiographic images |
11,044 |
10,784 |
$337K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,894 |
21,355 |
$306K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,107 |
18,093 |
$278K |
| D0220 |
Intraoral - periapical first radiographic image |
19,934 |
19,285 |
$233K |
| D0272 |
Bitewings - two radiographic images |
7,833 |
7,630 |
$155K |
| D9248 |
|
911 |
841 |
$98K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,914 |
2,824 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
1,139 |
1,139 |
$75K |
| D0330 |
Panoramic radiographic image |
3,156 |
3,067 |
$73K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
677 |
306 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,391 |
1,350 |
$46K |
| D2335 |
|
184 |
63 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
869 |
837 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
290 |
165 |
$14K |
| D2332 |
|
33 |
13 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
25 |
$4K |
| D2330 |
|
19 |
12 |
$1K |
| D9610 |
|
12 |
12 |
$215.04 |
| D0160 |
|
12 |
12 |
$164.45 |
| D0270 |
|
13 |
13 |
$53.90 |
| D0603 |
|
27,430 |
26,852 |
$0.01 |