| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,430 |
2,028 |
$613K |
| D1351 |
Sealant - per tooth |
18,988 |
3,126 |
$462K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,810 |
543 |
$378K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,690 |
2,648 |
$365K |
| D1120 |
Prophylaxis - child |
6,935 |
6,634 |
$229K |
| D0120 |
Periodic oral evaluation - established patient |
6,064 |
5,822 |
$162K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,844 |
8,459 |
$119K |
| D1110 |
Prophylaxis - adult |
2,376 |
2,265 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,369 |
3,151 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
8,577 |
8,127 |
$94K |
| D0272 |
Bitewings - two radiographic images |
4,874 |
4,675 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,256 |
538 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,395 |
7,631 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,823 |
2,690 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,958 |
1,851 |
$49K |
| D0330 |
Panoramic radiographic image |
1,314 |
1,233 |
$39K |
| D9248 |
|
226 |
217 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
132 |
132 |
$9K |
| D2332 |
|
67 |
26 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
84 |
37 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
236 |
221 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
12 |
$2K |
| D2330 |
|
23 |
12 |
$2K |
| D0603 |
|
11,968 |
11,722 |
$0.10 |