| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,688 |
10,139 |
$1.47M |
| D0120 |
Periodic oral evaluation - established patient |
52,483 |
51,383 |
$1.38M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,861 |
2,574 |
$1.16M |
| D1120 |
Prophylaxis - child |
40,890 |
39,964 |
$1.13M |
| D1206 |
Topical application of fluoride varnish |
57,741 |
56,420 |
$942K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,328 |
8,286 |
$907K |
| D1110 |
Prophylaxis - adult |
18,436 |
18,038 |
$716K |
| D1351 |
Sealant - per tooth |
18,251 |
6,329 |
$505K |
| D0220 |
Intraoral - periapical first radiographic image |
32,719 |
31,774 |
$497K |
| D0330 |
Panoramic radiographic image |
8,099 |
7,941 |
$439K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,891 |
15,649 |
$356K |
| D0274 |
Bitewings - four radiographic images |
10,461 |
10,222 |
$335K |
| D0272 |
Bitewings - two radiographic images |
17,700 |
17,318 |
$324K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,805 |
6,394 |
$308K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,325 |
1,881 |
$305K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,629 |
6,452 |
$298K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,857 |
2,375 |
$248K |
| D0140 |
Limited oral evaluation - problem focused |
3,074 |
2,959 |
$114K |
| D9420 |
|
943 |
923 |
$114K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
994 |
334 |
$84K |
| D2332 |
|
566 |
250 |
$56K |
| D2934 |
|
304 |
87 |
$55K |
| D2331 |
|
616 |
451 |
$52K |
| D0240 |
|
1,485 |
1,291 |
$33K |
| D2330 |
|
434 |
246 |
$30K |
| D0145 |
Oral evaluation for a patient under three years of age |
464 |
366 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
145 |
116 |
$13K |
| D2335 |
|
95 |
57 |
$12K |
| D2140 |
|
114 |
84 |
$8K |
| D2394 |
|
35 |
27 |
$6K |
| D1510 |
|
26 |
12 |
$3K |
| D2160 |
|
23 |
18 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
50 |
50 |
$834.00 |