| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28,201 |
13,974 |
$3.33M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22,422 |
6,987 |
$2.90M |
| D1120 |
Prophylaxis - child |
59,042 |
56,937 |
$2.46M |
| D0120 |
Periodic oral evaluation - established patient |
70,701 |
68,163 |
$1.99M |
| D1351 |
Sealant - per tooth |
59,105 |
14,761 |
$1.91M |
| D1208 |
Topical application of fluoride, excluding varnish |
77,614 |
74,801 |
$1.70M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18,287 |
10,513 |
$1.68M |
| D1110 |
Prophylaxis - adult |
19,678 |
18,878 |
$1.13M |
| D7140 |
Extraction, erupted tooth or exposed root |
10,494 |
5,502 |
$1.05M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,930 |
3,806 |
$876K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
31,177 |
28,378 |
$719K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,269 |
3,119 |
$510K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,857 |
8,533 |
$430K |
| D0330 |
Panoramic radiographic image |
6,921 |
6,682 |
$312K |
| D0272 |
Bitewings - two radiographic images |
17,786 |
17,092 |
$293K |
| D2335 |
|
1,839 |
916 |
$279K |
| D0140 |
Limited oral evaluation - problem focused |
6,641 |
6,215 |
$270K |
| D3120 |
|
7,281 |
4,100 |
$248K |
| D0274 |
Bitewings - four radiographic images |
10,196 |
9,812 |
$245K |
| D1330 |
|
32,675 |
32,183 |
$203K |
| D0220 |
Intraoral - periapical first radiographic image |
14,586 |
13,538 |
$157K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,834 |
5,288 |
$89K |
| D2330 |
|
496 |
288 |
$38K |
| D0240 |
|
2,940 |
2,656 |
$33K |
| D2332 |
|
164 |
84 |
$19K |
| D0270 |
|
475 |
446 |
$5K |
| D1510 |
|
16 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$798.00 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$348.88 |