| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19,161 |
6,657 |
$1.84M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,592 |
4,021 |
$707K |
| D1351 |
Sealant - per tooth |
23,725 |
5,642 |
$583K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,237 |
4,150 |
$573K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,089 |
875 |
$543K |
| D0120 |
Periodic oral evaluation - established patient |
18,923 |
18,315 |
$515K |
| D1120 |
Prophylaxis - child |
13,508 |
13,101 |
$465K |
| D1110 |
Prophylaxis - adult |
6,594 |
6,373 |
$339K |
| D1206 |
Topical application of fluoride varnish |
19,028 |
18,521 |
$265K |
| D0274 |
Bitewings - four radiographic images |
8,066 |
7,804 |
$249K |
| D0220 |
Intraoral - periapical first radiographic image |
18,493 |
17,740 |
$210K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,538 |
16,506 |
$193K |
| D0272 |
Bitewings - two radiographic images |
9,913 |
9,631 |
$181K |
| D9248 |
|
1,079 |
1,009 |
$110K |
| D0330 |
Panoramic radiographic image |
2,940 |
2,836 |
$94K |
| D0210 |
Intraoral - complete series of radiographic images |
955 |
954 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,206 |
1,128 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
973 |
943 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,187 |
1,091 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
507 |
486 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
125 |
42 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
74 |
44 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
25 |
$2K |
| D2330 |
|
26 |
14 |
$2K |
| D7111 |
|
19 |
14 |
$206.46 |
| D0270 |
|
48 |
46 |
$205.80 |
| D0603 |
|
24,892 |
24,362 |
$0.08 |