| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21,447 |
11,481 |
$543K |
| D1120 |
Prophylaxis - child |
28,565 |
27,729 |
$341K |
| D0120 |
Periodic oral evaluation - established patient |
33,795 |
32,821 |
$262K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,034 |
6,977 |
$231K |
| D1206 |
Topical application of fluoride varnish |
36,456 |
35,371 |
$214K |
| D0274 |
Bitewings - four radiographic images |
19,754 |
19,156 |
$173K |
| D0220 |
Intraoral - periapical first radiographic image |
40,187 |
38,773 |
$162K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,057 |
32,909 |
$133K |
| D1110 |
Prophylaxis - adult |
9,062 |
8,812 |
$132K |
| D0272 |
Bitewings - two radiographic images |
13,411 |
13,013 |
$86K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,719 |
2,043 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,088 |
4,932 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
5,320 |
5,083 |
$60K |
| D1351 |
Sealant - per tooth |
7,729 |
3,333 |
$60K |
| D0330 |
Panoramic radiographic image |
4,242 |
4,119 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,091 |
7,446 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
861 |
499 |
$32K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
582 |
441 |
$23K |
| D7111 |
|
907 |
642 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
366 |
215 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,384 |
1,357 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
137 |
94 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
307 |
306 |
$2K |
| D2332 |
|
41 |
24 |
$1K |
| D0270 |
|
356 |
317 |
$1K |
| D9248 |
|
29 |
29 |
$404.92 |
| D3120 |
|
74 |
56 |
$359.16 |
| D1354 |
|
77 |
28 |
$317.64 |
| D0601 |
|
3,133 |
2,923 |
$0.00 |
| D0602 |
|
2,256 |
2,180 |
$0.00 |
| D0603 |
|
5,733 |
5,405 |
$0.00 |