| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,269 |
7,546 |
$1.25M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,321 |
2,722 |
$916K |
| D1120 |
Prophylaxis - child |
22,876 |
22,244 |
$791K |
| D0120 |
Periodic oral evaluation - established patient |
25,203 |
24,461 |
$689K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,674 |
2,472 |
$593K |
| D1110 |
Prophylaxis - adult |
10,269 |
9,884 |
$492K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,536 |
12,498 |
$480K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,995 |
21,384 |
$434K |
| D0272 |
Bitewings - two radiographic images |
18,899 |
18,312 |
$403K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,333 |
2,267 |
$358K |
| D2931 |
|
1,858 |
1,183 |
$324K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
679 |
532 |
$295K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,725 |
2,347 |
$257K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,401 |
2,371 |
$235K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,967 |
4,761 |
$233K |
| D2390 |
|
938 |
334 |
$211K |
| D2950 |
|
1,632 |
1,066 |
$185K |
| D1206 |
Topical application of fluoride varnish |
7,038 |
6,801 |
$170K |
| D2332 |
|
1,054 |
580 |
$137K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,714 |
2,638 |
$124K |
| D1351 |
Sealant - per tooth |
3,333 |
970 |
$97K |
| D7111 |
|
1,526 |
922 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
3,614 |
3,382 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
2,795 |
2,719 |
$40K |
| D9243 |
|
387 |
278 |
$35K |
| D9239 |
|
395 |
361 |
$30K |
| D2330 |
|
249 |
174 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
986 |
493 |
$15K |
| D9420 |
|
117 |
108 |
$11K |
| D2335 |
|
56 |
41 |
$10K |
| D0330 |
Panoramic radiographic image |
104 |
102 |
$8K |
| D9248 |
|
70 |
40 |
$3K |