| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,418 |
2,942 |
$1.04M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,498 |
1,757 |
$420K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,332 |
2,323 |
$329K |
| D1351 |
Sealant - per tooth |
10,612 |
2,753 |
$291K |
| D1120 |
Prophylaxis - child |
6,359 |
6,288 |
$230K |
| D0120 |
Periodic oral evaluation - established patient |
7,565 |
7,456 |
$214K |
| D1110 |
Prophylaxis - adult |
2,516 |
2,469 |
$134K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,794 |
8,677 |
$127K |
| D0272 |
Bitewings - two radiographic images |
5,665 |
5,605 |
$126K |
| D0274 |
Bitewings - four radiographic images |
2,823 |
2,774 |
$89K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,863 |
2,805 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,389 |
1,373 |
$48K |
| D9248 |
|
386 |
383 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,323 |
3,257 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
570 |
324 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,797 |
2,395 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
441 |
440 |
$30K |
| D0330 |
Panoramic radiographic image |
987 |
978 |
$27K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
31 |
19 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
30 |
18 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
98 |
98 |
$2K |
| D0603 |
|
4,102 |
4,082 |
$0.00 |
| D0602 |
|
7,048 |
7,010 |
$0.00 |
| D0601 |
|
53 |
53 |
$0.00 |