| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,767 |
2,056 |
$361K |
| D0120 |
Periodic oral evaluation - established patient |
7,803 |
7,745 |
$222K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,691 |
1,437 |
$200K |
| D1120 |
Prophylaxis - child |
5,021 |
4,990 |
$182K |
| D1351 |
Sealant - per tooth |
6,593 |
1,873 |
$177K |
| D1110 |
Prophylaxis - adult |
3,102 |
3,082 |
$166K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
953 |
463 |
$139K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,595 |
4,017 |
$121K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,072 |
8,024 |
$117K |
| D0272 |
Bitewings - two radiographic images |
4,451 |
4,430 |
$98K |
| D0145 |
Oral evaluation for a patient under three years of age |
596 |
590 |
$82K |
| D0274 |
Bitewings - four radiographic images |
2,590 |
2,563 |
$79K |
| D0210 |
Intraoral - complete series of radiographic images |
415 |
415 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,125 |
2,054 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,224 |
1,091 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
293 |
170 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
139 |
76 |
$12K |
| D0330 |
Panoramic radiographic image |
694 |
689 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$317.88 |
| D0603 |
|
9,080 |
9,015 |
$0.00 |