| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,851 |
3,541 |
$492K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,738 |
2,070 |
$471K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,032 |
2,932 |
$398K |
| D1120 |
Prophylaxis - child |
10,189 |
9,848 |
$323K |
| D0120 |
Periodic oral evaluation - established patient |
12,180 |
11,789 |
$301K |
| D1351 |
Sealant - per tooth |
11,429 |
2,183 |
$284K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,292 |
6,255 |
$209K |
| D9248 |
|
1,881 |
1,775 |
$191K |
| D1206 |
Topical application of fluoride varnish |
13,860 |
13,394 |
$185K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,755 |
1,817 |
$183K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,290 |
6,779 |
$175K |
| D1110 |
Prophylaxis - adult |
2,764 |
2,683 |
$132K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,953 |
1,334 |
$128K |
| D0272 |
Bitewings - two radiographic images |
5,927 |
5,738 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
9,083 |
8,516 |
$98K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,114 |
790 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,919 |
2,826 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,612 |
2,466 |
$78K |
| D0330 |
Panoramic radiographic image |
2,070 |
2,016 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
640 |
640 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,167 |
1,119 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
158 |
134 |
$15K |
| D2332 |
|
101 |
64 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
18 |
12 |
$8K |
| D2931 |
|
46 |
28 |
$6K |
| D1510 |
|
35 |
24 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
250 |
250 |
$3K |
| D2934 |
|
23 |
12 |
$3K |
| D2950 |
|
39 |
24 |
$1K |
| D0603 |
|
17,729 |
17,096 |
$1K |
| D3120 |
|
29 |
14 |
$213.50 |
| D1999 |
|
1,520 |
1,313 |
$0.00 |
| D0350 |
|
14 |
13 |
$0.00 |
| D9986 |
|
361 |
348 |
$0.00 |