| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,262 |
9,666 |
$2.02M |
| D1120 |
Prophylaxis - child |
33,382 |
32,895 |
$1.47M |
| D7140 |
Extraction, erupted tooth or exposed root |
12,029 |
7,024 |
$1.34M |
| D1351 |
Sealant - per tooth |
35,748 |
10,495 |
$1.23M |
| D1206 |
Topical application of fluoride varnish |
43,131 |
42,499 |
$1.08M |
| D0120 |
Periodic oral evaluation - established patient |
33,190 |
32,702 |
$991K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,673 |
2,759 |
$737K |
| D9248 |
|
3,716 |
3,457 |
$685K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,776 |
8,657 |
$470K |
| D0272 |
Bitewings - two radiographic images |
26,733 |
26,341 |
$412K |
| D1110 |
Prophylaxis - adult |
6,531 |
6,448 |
$409K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,338 |
1,865 |
$364K |
| D0330 |
Panoramic radiographic image |
7,719 |
7,587 |
$334K |
| D0140 |
Limited oral evaluation - problem focused |
7,133 |
6,785 |
$316K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,095 |
2,240 |
$302K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,910 |
11,669 |
$238K |
| D0274 |
Bitewings - four radiographic images |
7,241 |
7,140 |
$166K |
| D1330 |
|
21,593 |
21,269 |
$134K |
| D4355 |
|
1,194 |
1,181 |
$119K |
| D3120 |
|
2,897 |
2,145 |
$100K |
| D8670 |
Periodic orthodontic treatment visit |
1,236 |
1,182 |
$92K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,401 |
848 |
$83K |
| D9310 |
|
887 |
871 |
$42K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
55 |
53 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,757 |
3,580 |
$38K |
| D0240 |
|
1,940 |
1,903 |
$31K |
| D2335 |
|
128 |
65 |
$19K |
| D2332 |
|
158 |
101 |
$19K |
| D4341 |
|
118 |
39 |
$11K |
| D1510 |
|
66 |
62 |
$5K |
| D2330 |
|
40 |
25 |
$3K |
| D8660 |
|
12 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
180 |
178 |
$1K |
| D9420 |
|
70 |
68 |
$1K |