| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,969 |
5,065 |
$1.72M |
| D1351 |
Sealant - per tooth |
22,579 |
5,406 |
$1.05M |
| D1120 |
Prophylaxis - child |
17,349 |
16,991 |
$940K |
| D1206 |
Topical application of fluoride varnish |
21,633 |
21,219 |
$716K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,421 |
18,795 |
$619K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,502 |
1,537 |
$592K |
| D0120 |
Periodic oral evaluation - established patient |
14,460 |
14,070 |
$580K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,812 |
2,657 |
$578K |
| D0220 |
Intraoral - periapical first radiographic image |
19,464 |
18,888 |
$464K |
| D0272 |
Bitewings - two radiographic images |
11,026 |
10,722 |
$400K |
| D0330 |
Panoramic radiographic image |
4,659 |
4,503 |
$381K |
| D0274 |
Bitewings - four radiographic images |
6,353 |
6,130 |
$325K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,087 |
4,834 |
$320K |
| D1110 |
Prophylaxis - adult |
4,298 |
4,155 |
$295K |
| D8660 |
|
781 |
754 |
$257K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,178 |
844 |
$172K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,077 |
1,894 |
$133K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
598 |
511 |
$133K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,221 |
2,158 |
$117K |
| D7111 |
|
967 |
676 |
$104K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
607 |
522 |
$100K |
| D9920 |
|
524 |
493 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
784 |
760 |
$47K |
| D2394 |
|
175 |
128 |
$46K |
| D8090 |
|
22 |
21 |
$34K |
| D8670 |
Periodic orthodontic treatment visit |
177 |
168 |
$26K |
| D2330 |
|
89 |
64 |
$12K |
| D1354 |
|
152 |
39 |
$10K |
| D0350 |
|
105 |
104 |
$6K |
| D0273 |
|
67 |
67 |
$3K |
| D0270 |
|
53 |
48 |
$1K |
| D0603 |
|
9,264 |
9,033 |
$0.00 |
| D0602 |
|
12,553 |
12,306 |
$0.00 |