| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
3,360 |
1,759 |
$305K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,380 |
668 |
$183K |
| D2740 |
Crown - porcelain/ceramic |
264 |
150 |
$156K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
675 |
397 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,622 |
1,609 |
$70K |
| D1120 |
Prophylaxis - child |
1,657 |
1,635 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,338 |
2,298 |
$56K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
398 |
87 |
$56K |
| D1110 |
Prophylaxis - adult |
892 |
874 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
298 |
167 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
814 |
809 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,520 |
1,488 |
$43K |
| D8660 |
|
257 |
257 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,574 |
2,521 |
$34K |
| D0274 |
Bitewings - four radiographic images |
935 |
919 |
$29K |
| D1206 |
Topical application of fluoride varnish |
859 |
845 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,254 |
1,232 |
$17K |
| D0272 |
Bitewings - two radiographic images |
678 |
671 |
$15K |
| D0330 |
Panoramic radiographic image |
238 |
237 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
230 |
225 |
$9K |
| D2950 |
|
67 |
42 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
261 |
245 |
$8K |
| D1351 |
Sealant - per tooth |
222 |
71 |
$8K |
| D2934 |
|
41 |
13 |
$7K |
| D4910 |
|
59 |
58 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
42 |
14 |
$4K |
| D4342 |
|
37 |
15 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
83 |
82 |
$3K |
| D0340 |
|
40 |
40 |
$2K |
| D4346 |
|
26 |
26 |
$1K |
| D0160 |
|
15 |
15 |
$999.88 |
| D0460 |
|
29 |
28 |
$806.44 |