| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,674 |
1,793 |
$561K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,251 |
1,246 |
$173K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,801 |
940 |
$136K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
910 |
198 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,778 |
2,740 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,083 |
2,515 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
971 |
961 |
$66K |
| D1120 |
Prophylaxis - child |
1,675 |
1,654 |
$58K |
| D1351 |
Sealant - per tooth |
2,086 |
566 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,931 |
1,884 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,478 |
2,441 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,702 |
2,660 |
$32K |
| D0274 |
Bitewings - four radiographic images |
880 |
867 |
$29K |
| D1110 |
Prophylaxis - adult |
574 |
562 |
$29K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
338 |
85 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
895 |
880 |
$25K |
| D9248 |
|
231 |
225 |
$24K |
| D0272 |
Bitewings - two radiographic images |
707 |
701 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
121 |
81 |
$13K |
| D1330 |
|
1,031 |
1,022 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
346 |
337 |
$4K |
| D0350 |
|
60 |
59 |
$606.54 |
| D7111 |
|
20 |
12 |
$229.40 |
| D0603 |
|
5,441 |
5,390 |
$0.00 |