| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,891 |
4,449 |
$869K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,955 |
3,915 |
$546K |
| D0120 |
Periodic oral evaluation - established patient |
16,472 |
16,285 |
$466K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,556 |
3,291 |
$422K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,017 |
14,438 |
$411K |
| D1351 |
Sealant - per tooth |
14,576 |
4,576 |
$385K |
| D1120 |
Prophylaxis - child |
11,017 |
10,896 |
$384K |
| D1110 |
Prophylaxis - adult |
5,346 |
5,287 |
$284K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,669 |
371 |
$244K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,994 |
16,805 |
$239K |
| D0220 |
Intraoral - periapical first radiographic image |
15,506 |
15,304 |
$190K |
| D0274 |
Bitewings - four radiographic images |
5,427 |
5,356 |
$184K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,085 |
6,875 |
$183K |
| D0210 |
Intraoral - complete series of radiographic images |
2,405 |
2,382 |
$164K |
| D0272 |
Bitewings - two radiographic images |
4,761 |
4,718 |
$109K |
| D9248 |
|
748 |
726 |
$85K |
| D0350 |
|
2,989 |
2,932 |
$43K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
516 |
161 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
700 |
689 |
$24K |
| D7240 |
Removal of impacted tooth - completely bony |
34 |
12 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
311 |
306 |
$6K |
| D1330 |
|
159 |
154 |
$2K |
| D0603 |
|
22,475 |
22,241 |
$0.00 |