| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,019 |
1,897 |
$366K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,534 |
2,503 |
$339K |
| D0120 |
Periodic oral evaluation - established patient |
10,476 |
10,282 |
$289K |
| D1120 |
Prophylaxis - child |
7,711 |
7,570 |
$270K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,665 |
9,575 |
$179K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,853 |
10,667 |
$153K |
| D1110 |
Prophylaxis - adult |
2,914 |
2,872 |
$151K |
| D1351 |
Sealant - per tooth |
5,502 |
1,574 |
$145K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,950 |
1,017 |
$142K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
978 |
338 |
$133K |
| D0220 |
Intraoral - periapical first radiographic image |
10,464 |
10,190 |
$124K |
| D0272 |
Bitewings - two radiographic images |
4,995 |
4,903 |
$112K |
| D0274 |
Bitewings - four radiographic images |
2,443 |
2,407 |
$81K |
| D9248 |
|
689 |
659 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
874 |
859 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,616 |
1,547 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
250 |
184 |
$21K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
74 |
38 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
240 |
228 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
71 |
40 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24 |
24 |
$773.49 |
| D0603 |
|
12,285 |
12,105 |
$0.00 |
| D0602 |
|
812 |
803 |
$0.00 |
| D0601 |
|
130 |
126 |
$0.00 |