| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14,468 |
4,656 |
$1.12M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,786 |
3,444 |
$883K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,802 |
2,786 |
$393K |
| D1120 |
Prophylaxis - child |
8,060 |
8,011 |
$292K |
| D0120 |
Periodic oral evaluation - established patient |
9,135 |
9,092 |
$261K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,651 |
8,855 |
$223K |
| D1351 |
Sealant - per tooth |
7,029 |
2,330 |
$191K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,796 |
6,666 |
$180K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,684 |
11,619 |
$170K |
| D1110 |
Prophylaxis - adult |
3,036 |
3,023 |
$165K |
| D0210 |
Intraoral - complete series of radiographic images |
2,252 |
2,239 |
$155K |
| D0220 |
Intraoral - periapical first radiographic image |
9,432 |
9,357 |
$116K |
| D0274 |
Bitewings - four radiographic images |
2,884 |
2,870 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,057 |
2,043 |
$72K |
| D0272 |
Bitewings - two radiographic images |
2,315 |
2,306 |
$54K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
38 |
16 |
$6K |
| D2330 |
|
50 |
26 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
24 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
39 |
$708.33 |
| D1352 |
|
24 |
13 |
$386.96 |
| D7111 |
|
20 |
15 |
$229.40 |
| D0240 |
|
12 |
12 |
$117.60 |
| D0603 |
|
15,124 |
15,039 |
$0.00 |
| D0602 |
|
68 |
68 |
$0.00 |
| D0601 |
|
17 |
17 |
$0.00 |