| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,577 |
2,312 |
$420K |
| D1120 |
Prophylaxis - child |
13,353 |
12,718 |
$363K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,764 |
841 |
$277K |
| D0120 |
Periodic oral evaluation - established patient |
12,944 |
12,320 |
$260K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,609 |
13,903 |
$242K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,657 |
1,422 |
$205K |
| D0272 |
Bitewings - two radiographic images |
6,163 |
5,832 |
$111K |
| D1351 |
Sealant - per tooth |
4,386 |
1,079 |
$109K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,722 |
716 |
$103K |
| D0330 |
Panoramic radiographic image |
2,045 |
1,934 |
$92K |
| D0140 |
Limited oral evaluation - problem focused |
2,903 |
2,725 |
$76K |
| D1110 |
Prophylaxis - adult |
1,223 |
1,167 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,588 |
1,507 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,345 |
2,092 |
$35K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
89 |
41 |
$10K |
| D9420 |
|
289 |
268 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
26 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
300 |
271 |
$3K |
| D2330 |
|
44 |
25 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
27 |
$1K |
| D9310 |
|
31 |
31 |
$848.08 |
| D0230 |
Intraoral - periapical each additional radiographic image |
97 |
89 |
$684.70 |
| D1999 |
|
117 |
103 |
$0.00 |