| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,572 |
2,333 |
$541K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,881 |
2,865 |
$401K |
| D1351 |
Sealant - per tooth |
6,831 |
1,926 |
$176K |
| D1120 |
Prophylaxis - child |
4,874 |
4,803 |
$169K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,998 |
1,093 |
$147K |
| D0210 |
Intraoral - complete series of radiographic images |
1,949 |
1,904 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
4,040 |
3,947 |
$112K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,444 |
3,283 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,439 |
6,329 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,206 |
2,159 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,888 |
3,599 |
$61K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
377 |
204 |
$54K |
| D1110 |
Prophylaxis - adult |
950 |
921 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,985 |
3,895 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,927 |
1,891 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
397 |
243 |
$38K |
| D0274 |
Bitewings - four radiographic images |
714 |
692 |
$22K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
120 |
80 |
$10K |
| D2330 |
|
65 |
43 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
70 |
50 |
$3K |
| D0350 |
|
194 |
186 |
$1K |
| D1330 |
|
61 |
58 |
$525.78 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
25 |
$488.28 |
| D7111 |
|
44 |
24 |
$389.09 |
| D0603 |
|
10,650 |
10,524 |
$0.00 |