| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14,439 |
3,849 |
$1.08M |
| D0145 |
Oral evaluation for a patient under three years of age |
3,092 |
3,071 |
$433K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,261 |
1,074 |
$216K |
| D1120 |
Prophylaxis - child |
5,610 |
5,558 |
$202K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,462 |
6,047 |
$165K |
| D0120 |
Periodic oral evaluation - established patient |
5,623 |
5,588 |
$160K |
| D1351 |
Sealant - per tooth |
4,618 |
1,729 |
$120K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,885 |
7,820 |
$114K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,258 |
4,182 |
$112K |
| D0210 |
Intraoral - complete series of radiographic images |
1,568 |
1,554 |
$107K |
| D1110 |
Prophylaxis - adult |
1,929 |
1,918 |
$104K |
| D0220 |
Intraoral - periapical first radiographic image |
6,463 |
6,389 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,167 |
2,142 |
$74K |
| D0274 |
Bitewings - four radiographic images |
1,758 |
1,743 |
$59K |
| D0272 |
Bitewings - two radiographic images |
1,579 |
1,568 |
$36K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
43 |
14 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
33 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
55 |
$955.90 |
| D1330 |
|
55 |
55 |
$539.00 |
| D0603 |
|
11,628 |
11,534 |
$0.00 |