| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,903 |
4,339 |
$589K |
| D1120 |
Prophylaxis - child |
18,439 |
17,449 |
$490K |
| D0120 |
Periodic oral evaluation - established patient |
21,900 |
20,799 |
$396K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,092 |
2,427 |
$368K |
| D0240 |
|
18,065 |
8,693 |
$314K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,105 |
3,067 |
$309K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,754 |
19,667 |
$290K |
| D1999 |
|
14,922 |
13,659 |
$284K |
| D0330 |
Panoramic radiographic image |
5,570 |
5,283 |
$245K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,872 |
10,373 |
$238K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,985 |
2,272 |
$209K |
| D1110 |
Prophylaxis - adult |
5,517 |
5,281 |
$194K |
| D0272 |
Bitewings - two radiographic images |
7,905 |
7,550 |
$135K |
| D1206 |
Topical application of fluoride varnish |
5,299 |
4,978 |
$119K |
| D1351 |
Sealant - per tooth |
5,246 |
1,402 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,593 |
4,299 |
$112K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,424 |
917 |
$104K |
| D0274 |
Bitewings - four radiographic images |
2,782 |
2,677 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
443 |
285 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,774 |
2,568 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
818 |
726 |
$20K |
| D2330 |
|
180 |
109 |
$9K |
| D9110 |
|
132 |
126 |
$5K |
| D3240 |
|
34 |
24 |
$5K |
| D2332 |
|
43 |
29 |
$4K |
| D3120 |
|
35 |
27 |
$613.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
53 |
38 |
$465.50 |