| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
11,221 |
6,123 |
$1.39M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,732 |
6,843 |
$1.28M |
| D2940 |
|
25,601 |
3,848 |
$1.21M |
| D1120 |
Prophylaxis - child |
29,437 |
29,422 |
$1.03M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
22,955 |
22,869 |
$942K |
| D1351 |
Sealant - per tooth |
20,480 |
6,074 |
$617K |
| D0330 |
Panoramic radiographic image |
11,276 |
11,252 |
$567K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,942 |
3,305 |
$540K |
| D0230 |
Intraoral - periapical each additional radiographic image |
49,414 |
38,492 |
$523K |
| D0220 |
Intraoral - periapical first radiographic image |
39,704 |
39,531 |
$515K |
| D0272 |
Bitewings - two radiographic images |
26,605 |
26,580 |
$506K |
| D1208 |
Topical application of fluoride, excluding varnish |
30,515 |
30,422 |
$495K |
| D1110 |
Prophylaxis - adult |
7,542 |
7,461 |
$364K |
| D0120 |
Periodic oral evaluation - established patient |
12,217 |
12,206 |
$284K |
| D2394 |
|
1,688 |
1,179 |
$261K |
| D2332 |
|
1,286 |
757 |
$136K |
| D1206 |
Topical application of fluoride varnish |
6,544 |
6,541 |
$111K |
| D0274 |
Bitewings - four radiographic images |
2,209 |
2,170 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
706 |
706 |
$27K |
| D2330 |
|
394 |
277 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
112 |
80 |
$16K |
| D2331 |
|
117 |
91 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
35 |
27 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
42 |
42 |
$2K |
| D0160 |
|
13 |
13 |
$1K |