| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,435 |
3,964 |
$760K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,843 |
1,164 |
$516K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,545 |
2,874 |
$390K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,471 |
2,420 |
$339K |
| D0120 |
Periodic oral evaluation - established patient |
12,487 |
11,948 |
$338K |
| D1120 |
Prophylaxis - child |
7,905 |
7,591 |
$272K |
| D1351 |
Sealant - per tooth |
10,556 |
3,074 |
$262K |
| D1110 |
Prophylaxis - adult |
4,769 |
4,591 |
$243K |
| D0274 |
Bitewings - four radiographic images |
6,741 |
6,444 |
$213K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,631 |
12,123 |
$174K |
| D0220 |
Intraoral - periapical first radiographic image |
12,422 |
11,820 |
$145K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,554 |
979 |
$140K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,883 |
11,119 |
$126K |
| D0210 |
Intraoral - complete series of radiographic images |
1,851 |
1,793 |
$118K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,825 |
3,601 |
$96K |
| D0272 |
Bitewings - two radiographic images |
4,170 |
4,002 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,579 |
1,494 |
$50K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
590 |
235 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
468 |
242 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
837 |
817 |
$14K |
| D2332 |
|
84 |
53 |
$9K |
| D1330 |
|
924 |
857 |
$9K |
| D2331 |
|
73 |
54 |
$6K |
| D2330 |
|
59 |
39 |
$4K |
| D7111 |
|
396 |
235 |
$4K |
| D1352 |
|
71 |
41 |
$1K |
| D0601 |
|
2,449 |
2,371 |
$12.00 |
| D0603 |
|
8,483 |
8,112 |
$0.03 |
| D0602 |
|
5,486 |
5,329 |
$0.00 |
| D9986 |
|
231 |
226 |
$0.00 |