| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,550 |
5,834 |
$1.22M |
| D1351 |
Sealant - per tooth |
21,712 |
6,115 |
$584K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,222 |
3,208 |
$451K |
| D0120 |
Periodic oral evaluation - established patient |
15,574 |
15,405 |
$439K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,896 |
2,716 |
$373K |
| D1120 |
Prophylaxis - child |
9,839 |
9,740 |
$352K |
| D1110 |
Prophylaxis - adult |
6,330 |
6,268 |
$339K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,083 |
14,876 |
$292K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,638 |
16,465 |
$238K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,069 |
7,833 |
$211K |
| D0220 |
Intraoral - periapical first radiographic image |
15,833 |
15,584 |
$193K |
| D0274 |
Bitewings - four radiographic images |
4,759 |
4,716 |
$161K |
| D0272 |
Bitewings - two radiographic images |
6,586 |
6,511 |
$151K |
| D0210 |
Intraoral - complete series of radiographic images |
1,402 |
1,387 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
860 |
849 |
$29K |
| D2330 |
|
342 |
219 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
179 |
113 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
109 |
40 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
91 |
35 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
185 |
183 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
27 |
$2K |
| D7111 |
|
86 |
48 |
$929.07 |
| D0603 |
|
19,604 |
19,440 |
$0.00 |
| D0601 |
|
1,280 |
1,275 |
$0.00 |