| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,312 |
2,837 |
$812K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,502 |
712 |
$352K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,010 |
1,998 |
$279K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,867 |
6,501 |
$270K |
| D1351 |
Sealant - per tooth |
8,878 |
2,425 |
$237K |
| D1120 |
Prophylaxis - child |
6,525 |
6,466 |
$233K |
| D0120 |
Periodic oral evaluation - established patient |
6,092 |
6,039 |
$172K |
| D9248 |
|
1,356 |
1,343 |
$154K |
| D0210 |
Intraoral - complete series of radiographic images |
2,032 |
2,026 |
$136K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,646 |
836 |
$126K |
| D1206 |
Topical application of fluoride varnish |
8,690 |
8,618 |
$125K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,552 |
475 |
$123K |
| D1110 |
Prophylaxis - adult |
1,870 |
1,859 |
$100K |
| D0220 |
Intraoral - periapical first radiographic image |
7,404 |
7,293 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,567 |
2,548 |
$88K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,933 |
2,765 |
$77K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,038 |
491 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,154 |
1,143 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,244 |
1,225 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
971 |
950 |
$18K |
| D2332 |
|
28 |
19 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
115 |
115 |
$2K |
| D0603 |
|
11,543 |
11,486 |
$0.00 |
| D9986 |
|
643 |
626 |
$0.00 |