| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,737 |
3,678 |
$657K |
| D0120 |
Periodic oral evaluation - established patient |
21,195 |
21,030 |
$605K |
| D1120 |
Prophylaxis - child |
15,871 |
15,774 |
$573K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,185 |
21,039 |
$437K |
| D1110 |
Prophylaxis - adult |
7,812 |
7,735 |
$386K |
| D0210 |
Intraoral - complete series of radiographic images |
4,867 |
4,814 |
$310K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,786 |
1,601 |
$291K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,308 |
548 |
$205K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,316 |
4,841 |
$195K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,805 |
1,101 |
$175K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,498 |
6,799 |
$174K |
| D0220 |
Intraoral - periapical first radiographic image |
9,195 |
8,919 |
$123K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,141 |
483 |
$110K |
| D1351 |
Sealant - per tooth |
3,681 |
1,176 |
$101K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,919 |
1,915 |
$88K |
| D0272 |
Bitewings - two radiographic images |
3,659 |
3,627 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
2,430 |
2,355 |
$35K |
| D9420 |
|
160 |
135 |
$13K |
| D2330 |
|
59 |
31 |
$5K |
| D7111 |
|
36 |
24 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$568.44 |
| D1999 |
|
55 |
52 |
$200.00 |