| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,009 |
910 |
$283K |
| D1351 |
Sealant - per tooth |
6,397 |
877 |
$114K |
| D1120 |
Prophylaxis - child |
2,649 |
2,297 |
$113K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,904 |
1,494 |
$108K |
| D1354 |
|
4,499 |
778 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,178 |
996 |
$69K |
| D1206 |
Topical application of fluoride varnish |
2,500 |
2,194 |
$64K |
| D0272 |
Bitewings - two radiographic images |
1,947 |
1,706 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
460 |
237 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
2,415 |
2,057 |
$49K |
| D0330 |
Panoramic radiographic image |
591 |
507 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,952 |
1,752 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,450 |
1,314 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
222 |
147 |
$44K |
| D9310 |
|
345 |
287 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
162 |
115 |
$19K |
| D1110 |
Prophylaxis - adult |
239 |
216 |
$14K |
| D0274 |
Bitewings - four radiographic images |
311 |
279 |
$14K |
| D1330 |
|
1,607 |
1,330 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
165 |
149 |
$9K |
| D2332 |
|
50 |
37 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
484 |
406 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
35 |
16 |
$5K |
| D1510 |
|
14 |
12 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
34 |
17 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
30 |
20 |
$1K |
| D0601 |
|
71 |
65 |
$0.00 |
| D0603 |
|
710 |
622 |
$0.00 |
| D0602 |
|
138 |
109 |
$0.00 |
| D1310 |
|
55 |
50 |
$0.00 |
| D1999 |
|
1,133 |
873 |
$0.00 |