| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,962 |
4,187 |
$757K |
| D1120 |
Prophylaxis - child |
14,857 |
14,122 |
$396K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,503 |
1,121 |
$365K |
| D0120 |
Periodic oral evaluation - established patient |
13,575 |
12,992 |
$347K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,588 |
7,046 |
$327K |
| D1351 |
Sealant - per tooth |
10,190 |
2,757 |
$284K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,306 |
14,533 |
$250K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,580 |
1,736 |
$212K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,273 |
1,194 |
$186K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,463 |
1,618 |
$158K |
| D0272 |
Bitewings - two radiographic images |
6,800 |
6,472 |
$119K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
796 |
615 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,495 |
2,287 |
$105K |
| D0220 |
Intraoral - periapical first radiographic image |
6,489 |
6,159 |
$98K |
| D0330 |
Panoramic radiographic image |
1,880 |
1,788 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,397 |
4,585 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
1,798 |
1,682 |
$65K |
| D9420 |
|
514 |
483 |
$59K |
| D1110 |
Prophylaxis - adult |
559 |
545 |
$21K |
| D1510 |
|
281 |
192 |
$21K |
| D2330 |
|
300 |
203 |
$20K |
| D2390 |
|
80 |
28 |
$14K |
| D2331 |
|
86 |
69 |
$7K |
| D0274 |
Bitewings - four radiographic images |
156 |
150 |
$4K |