| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,767 |
8,823 |
$1.76M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,741 |
6,038 |
$838K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,163 |
4,142 |
$585K |
| D0120 |
Periodic oral evaluation - established patient |
20,116 |
19,990 |
$572K |
| D1120 |
Prophylaxis - child |
15,456 |
15,355 |
$556K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36,572 |
16,076 |
$411K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,267 |
13,016 |
$350K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,385 |
21,240 |
$308K |
| D0210 |
Intraoral - complete series of radiographic images |
4,603 |
4,578 |
$303K |
| D1110 |
Prophylaxis - adult |
5,359 |
5,323 |
$289K |
| D0220 |
Intraoral - periapical first radiographic image |
17,056 |
16,892 |
$209K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,936 |
1,117 |
$198K |
| D0272 |
Bitewings - two radiographic images |
6,129 |
6,087 |
$141K |
| D0274 |
Bitewings - four radiographic images |
3,774 |
3,747 |
$128K |
| D1351 |
Sealant - per tooth |
3,863 |
2,055 |
$104K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
510 |
287 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
804 |
798 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
531 |
522 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
134 |
81 |
$6K |
| D2332 |
|
36 |
29 |
$5K |
| D2330 |
|
57 |
41 |
$4K |
| D0350 |
|
370 |
363 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
23 |
16 |
$2K |
| D0603 |
|
24,660 |
24,501 |
$0.00 |
| D0602 |
|
845 |
843 |
$0.00 |
| D0601 |
|
76 |
76 |
$0.00 |