| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,235 |
5,542 |
$1.08M |
| D0120 |
Periodic oral evaluation - established patient |
33,138 |
31,717 |
$845K |
| D1120 |
Prophylaxis - child |
28,803 |
27,582 |
$774K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,118 |
2,004 |
$739K |
| D1208 |
Topical application of fluoride, excluding varnish |
35,384 |
33,817 |
$578K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,110 |
9,896 |
$485K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,678 |
3,206 |
$369K |
| D1351 |
Sealant - per tooth |
13,681 |
3,813 |
$369K |
| D1110 |
Prophylaxis - adult |
8,961 |
8,506 |
$334K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,125 |
2,803 |
$324K |
| D0272 |
Bitewings - two radiographic images |
13,008 |
12,421 |
$232K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,479 |
4,240 |
$192K |
| D0330 |
Panoramic radiographic image |
2,684 |
2,600 |
$146K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,786 |
968 |
$143K |
| D0274 |
Bitewings - four radiographic images |
4,418 |
4,197 |
$136K |
| D0140 |
Limited oral evaluation - problem focused |
3,482 |
3,317 |
$128K |
| D0220 |
Intraoral - periapical first radiographic image |
7,882 |
7,410 |
$116K |
| D9420 |
|
1,030 |
934 |
$115K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
812 |
615 |
$105K |
| D0240 |
|
4,751 |
2,413 |
$76K |
| D2390 |
|
333 |
132 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,158 |
2,549 |
$48K |
| D2332 |
|
364 |
239 |
$35K |
| D2330 |
|
396 |
251 |
$25K |
| D1510 |
|
133 |
91 |
$24K |
| D2335 |
|
19 |
12 |
$2K |
| D2331 |
|
17 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
34 |
34 |
$598.74 |
| D1999 |
|
12 |
12 |
$0.00 |