| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25,394 |
12,226 |
$1.98M |
| D0145 |
Oral evaluation for a patient under three years of age |
11,674 |
11,657 |
$1.65M |
| D0230 |
Intraoral - periapical each additional radiographic image |
122,125 |
41,998 |
$1.29M |
| D1120 |
Prophylaxis - child |
31,906 |
31,805 |
$1.16M |
| D0120 |
Periodic oral evaluation - established patient |
38,850 |
38,749 |
$1.11M |
| D1208 |
Topical application of fluoride, excluding varnish |
43,410 |
43,272 |
$629K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,176 |
3,742 |
$627K |
| D1110 |
Prophylaxis - adult |
10,846 |
10,809 |
$582K |
| D0220 |
Intraoral - periapical first radiographic image |
42,582 |
42,416 |
$483K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17,149 |
16,979 |
$455K |
| D0274 |
Bitewings - four radiographic images |
13,077 |
13,032 |
$423K |
| D0272 |
Bitewings - two radiographic images |
10,887 |
10,843 |
$239K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,028 |
589 |
$150K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,342 |
3,306 |
$114K |
| D0330 |
Panoramic radiographic image |
2,737 |
2,721 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
471 |
469 |
$33K |
| D2330 |
|
258 |
217 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
855 |
852 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
12 |
$512.48 |
| D7111 |
|
25 |
25 |
$286.75 |
| D0602 |
|
27,960 |
27,908 |
$0.00 |
| D0603 |
|
27,660 |
27,543 |
$0.00 |