| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,093 |
2,392 |
$420K |
| D0120 |
Periodic oral evaluation - established patient |
14,188 |
14,023 |
$303K |
| D1351 |
Sealant - per tooth |
14,365 |
3,422 |
$270K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,573 |
2,546 |
$252K |
| D1120 |
Prophylaxis - child |
9,795 |
9,658 |
$247K |
| D1110 |
Prophylaxis - adult |
4,581 |
4,518 |
$176K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,590 |
14,388 |
$141K |
| D0220 |
Intraoral - periapical first radiographic image |
15,237 |
14,915 |
$129K |
| D0272 |
Bitewings - two radiographic images |
7,937 |
7,803 |
$125K |
| D1206 |
Topical application of fluoride varnish |
11,176 |
11,016 |
$112K |
| D0274 |
Bitewings - four radiographic images |
4,457 |
4,388 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,102 |
624 |
$62K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,959 |
2,839 |
$53K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
393 |
122 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,962 |
2,924 |
$31K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
23 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
93 |
90 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
51 |
49 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
14 |
$640.60 |
| D9310 |
|
54 |
53 |
$240.57 |
| D0330 |
Panoramic radiographic image |
31 |
30 |
$227.03 |
| D0160 |
|
14 |
14 |
$142.07 |
| D1330 |
|
391 |
379 |
$30.61 |
| D0603 |
|
15,535 |
15,324 |
$13.66 |
| D0602 |
|
1,623 |
1,606 |
$1.03 |
| D0601 |
|
38 |
34 |
$0.03 |