| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18,097 |
10,888 |
$1.74M |
| D1120 |
Prophylaxis - child |
66,499 |
59,054 |
$1.63M |
| D0120 |
Periodic oral evaluation - established patient |
66,168 |
59,687 |
$1.56M |
| D1206 |
Topical application of fluoride varnish |
96,211 |
85,661 |
$1.36M |
| D1351 |
Sealant - per tooth |
93,097 |
18,488 |
$1.18M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15,538 |
9,277 |
$1.10M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,576 |
1,660 |
$821K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
22,514 |
19,306 |
$811K |
| D1110 |
Prophylaxis - adult |
23,319 |
20,984 |
$791K |
| D0330 |
Panoramic radiographic image |
19,293 |
17,063 |
$772K |
| D0220 |
Intraoral - periapical first radiographic image |
46,741 |
40,940 |
$623K |
| D0272 |
Bitewings - two radiographic images |
38,623 |
34,005 |
$583K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,058 |
9,452 |
$445K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,729 |
3,595 |
$443K |
| D0274 |
Bitewings - four radiographic images |
15,627 |
14,028 |
$425K |
| D0140 |
Limited oral evaluation - problem focused |
12,326 |
10,832 |
$393K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,492 |
24,858 |
$343K |
| D9420 |
|
2,887 |
2,121 |
$234K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
250 |
178 |
$27K |
| D0160 |
|
519 |
413 |
$26K |
| 99199 |
Unlisted special service, procedure or report |
4,614 |
4,614 |
$26K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
345 |
153 |
$26K |
| D0145 |
Oral evaluation for a patient under three years of age |
962 |
818 |
$17K |
| D1354 |
|
2,654 |
842 |
$14K |
| D4355 |
|
171 |
146 |
$10K |
| D0270 |
|
854 |
785 |
$7K |
| D4346 |
|
133 |
122 |
$5K |
| D7111 |
|
116 |
34 |
$2K |
| D2332 |
|
21 |
12 |
$2K |
| D9110 |
|
43 |
29 |
$1K |
| D2330 |
|
16 |
13 |
$1K |
| D2331 |
|
15 |
12 |
$1K |
| D0170 |
|
14 |
14 |
$355.16 |
| D9311 |
|
17 |
16 |
$0.00 |
| D3120 |
|
23 |
19 |
$0.00 |
| D1999 |
|
89,091 |
77,090 |
$0.00 |
| D9996 |
|
9,572 |
8,721 |
$0.00 |
| D0191 |
|
4,387 |
4,248 |
$0.00 |
| D0350 |
|
11,659 |
10,690 |
$0.00 |
| D0190 |
|
99 |
99 |
$0.00 |
| D9993 |
|
146 |
145 |
$0.00 |