| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,764 |
1,684 |
$346K |
| D1351 |
Sealant - per tooth |
6,798 |
1,442 |
$177K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,136 |
1,196 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
5,527 |
5,475 |
$152K |
| D1120 |
Prophylaxis - child |
3,983 |
3,941 |
$139K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,103 |
5,477 |
$119K |
| D0145 |
Oral evaluation for a patient under three years of age |
817 |
814 |
$112K |
| D1110 |
Prophylaxis - adult |
1,994 |
1,974 |
$102K |
| D0274 |
Bitewings - four radiographic images |
2,708 |
2,680 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,957 |
5,899 |
$84K |
| D0220 |
Intraoral - periapical first radiographic image |
5,914 |
5,734 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,541 |
1,387 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,359 |
1,349 |
$31K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
201 |
109 |
$25K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
153 |
80 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
266 |
259 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
43 |
$6K |
| D2331 |
|
31 |
16 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
144 |
140 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
32 |
$2K |
| D2330 |
|
25 |
14 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
13 |
$792.78 |
| D0603 |
|
6,858 |
6,808 |
$0.00 |