| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26,639 |
13,549 |
$2.09M |
| D0145 |
Oral evaluation for a patient under three years of age |
12,888 |
12,851 |
$1.82M |
| D1120 |
Prophylaxis - child |
37,943 |
37,856 |
$1.37M |
| D0120 |
Periodic oral evaluation - established patient |
47,290 |
47,180 |
$1.35M |
| D1208 |
Topical application of fluoride, excluding varnish |
52,103 |
51,972 |
$756K |
| D1110 |
Prophylaxis - adult |
13,768 |
13,733 |
$741K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,418 |
3,972 |
$653K |
| D0230 |
Intraoral - periapical each additional radiographic image |
59,140 |
21,570 |
$635K |
| D0274 |
Bitewings - four radiographic images |
16,036 |
15,987 |
$534K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19,572 |
19,426 |
$524K |
| D0272 |
Bitewings - two radiographic images |
15,067 |
15,032 |
$340K |
| D0220 |
Intraoral - periapical first radiographic image |
23,485 |
23,417 |
$276K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,240 |
797 |
$182K |
| D0210 |
Intraoral - complete series of radiographic images |
2,393 |
2,387 |
$167K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,206 |
3,194 |
$110K |
| D0140 |
Limited oral evaluation - problem focused |
1,274 |
1,269 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
345 |
311 |
$17K |
| D2330 |
|
52 |
43 |
$4K |
| D0330 |
Panoramic radiographic image |
567 |
564 |
$3K |
| D7111 |
|
233 |
219 |
$3K |
| D0603 |
|
27,520 |
27,434 |
$0.00 |
| D0602 |
|
37,727 |
37,626 |
$0.00 |