| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,388 |
8,545 |
$1.09M |
| D1120 |
Prophylaxis - child |
19,641 |
19,641 |
$733K |
| D0120 |
Periodic oral evaluation - established patient |
18,033 |
18,033 |
$453K |
| D0274 |
Bitewings - four radiographic images |
17,829 |
17,829 |
$450K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,966 |
2,763 |
$299K |
| D1351 |
Sealant - per tooth |
3,823 |
3,562 |
$274K |
| D1206 |
Topical application of fluoride varnish |
9,859 |
9,797 |
$233K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,903 |
3,733 |
$226K |
| D0220 |
Intraoral - periapical first radiographic image |
18,981 |
18,959 |
$210K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,880 |
1,819 |
$162K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,124 |
2,036 |
$157K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,805 |
12,805 |
$146K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,487 |
3,344 |
$142K |
| D2331 |
|
1,519 |
1,454 |
$123K |
| D3240 |
|
612 |
569 |
$117K |
| D1110 |
Prophylaxis - adult |
2,454 |
2,454 |
$110K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,719 |
17,719 |
$98K |
| D0330 |
Panoramic radiographic image |
2,510 |
2,510 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,242 |
3,242 |
$78K |
| D1510 |
|
668 |
655 |
$63K |
| D9110 |
|
1,096 |
1,076 |
$24K |
| D0145 |
Oral evaluation for a patient under three years of age |
681 |
681 |
$17K |
| D2330 |
|
139 |
134 |
$7K |
| D3230 |
|
25 |
24 |
$4K |
| D2332 |
|
24 |
24 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
174 |
174 |
$2K |
| D9995 |
|
71 |
71 |
$2K |
| D2920 |
|
12 |
12 |
$385.92 |