| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,773 |
2,796 |
$486K |
| D1120 |
Prophylaxis - child |
14,862 |
11,660 |
$309K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,564 |
1,983 |
$276K |
| D1351 |
Sealant - per tooth |
13,369 |
2,691 |
$269K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,608 |
6,862 |
$219K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,319 |
676 |
$218K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,798 |
1,539 |
$180K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,966 |
11,748 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
5,151 |
4,730 |
$137K |
| D0330 |
Panoramic radiographic image |
3,315 |
2,747 |
$118K |
| D0272 |
Bitewings - two radiographic images |
7,422 |
5,633 |
$94K |
| D0140 |
Limited oral evaluation - problem focused |
2,672 |
2,185 |
$82K |
| D0274 |
Bitewings - four radiographic images |
2,688 |
2,219 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
428 |
300 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
2,452 |
2,091 |
$25K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
280 |
112 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
376 |
228 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
224 |
81 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
537 |
393 |
$4K |
| D2330 |
|
103 |
41 |
$4K |
| D2140 |
|
20 |
12 |
$1K |
| D1110 |
Prophylaxis - adult |
22 |
21 |
$190.40 |