| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,769 |
7,839 |
$1.51M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,703 |
4,438 |
$581K |
| D0120 |
Periodic oral evaluation - established patient |
16,952 |
16,735 |
$473K |
| D1120 |
Prophylaxis - child |
12,796 |
12,636 |
$447K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,308 |
13,515 |
$312K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,435 |
11,201 |
$291K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,416 |
18,177 |
$260K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,885 |
1,871 |
$258K |
| D0210 |
Intraoral - complete series of radiographic images |
3,265 |
3,220 |
$212K |
| D1110 |
Prophylaxis - adult |
3,895 |
3,849 |
$203K |
| D0220 |
Intraoral - periapical first radiographic image |
14,463 |
14,267 |
$174K |
| D1351 |
Sealant - per tooth |
5,580 |
1,768 |
$145K |
| D0272 |
Bitewings - two radiographic images |
4,769 |
4,707 |
$108K |
| D0274 |
Bitewings - four radiographic images |
2,567 |
2,536 |
$85K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
492 |
354 |
$70K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
108 |
80 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
216 |
128 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
259 |
247 |
$8K |
| D2330 |
|
61 |
30 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
36 |
28 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
166 |
162 |
$3K |
| D0350 |
|
30 |
29 |
$108.44 |
| D0603 |
|
22,359 |
22,124 |
$0.00 |