| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,538 |
5,270 |
$248K |
| D2750 |
|
863 |
665 |
$231K |
| D1120 |
Prophylaxis - child |
11,612 |
11,457 |
$213K |
| D1351 |
Sealant - per tooth |
12,346 |
2,740 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
10,345 |
9,600 |
$138K |
| D1206 |
Topical application of fluoride varnish |
11,655 |
11,502 |
$132K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,210 |
3,302 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,607 |
7,299 |
$97K |
| D9920 |
|
6,655 |
6,222 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,582 |
1,807 |
$76K |
| D1110 |
Prophylaxis - adult |
5,297 |
5,230 |
$75K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
322 |
266 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,020 |
4,558 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
16,726 |
16,083 |
$49K |
| D0601 |
|
12,218 |
11,634 |
$47K |
| D2952 |
|
699 |
565 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,263 |
14,158 |
$34K |
| D0272 |
Bitewings - two radiographic images |
6,441 |
6,327 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
2,416 |
2,218 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
922 |
737 |
$29K |
| D0274 |
Bitewings - four radiographic images |
3,218 |
3,164 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,933 |
3,875 |
$28K |
| D0330 |
Panoramic radiographic image |
1,206 |
1,195 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
186 |
146 |
$14K |
| D0602 |
|
2,718 |
2,594 |
$14K |
| D0270 |
|
3,787 |
3,708 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
521 |
521 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
725 |
702 |
$8K |
| D0603 |
|
1,412 |
1,362 |
$8K |
| D2332 |
|
190 |
143 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
179 |
140 |
$5K |
| D0191 |
|
570 |
501 |
$5K |
| D3320 |
|
15 |
13 |
$3K |
| D2330 |
|
27 |
25 |
$404.25 |
| D0240 |
|
18 |
12 |
$16.80 |
| D9310 |
|
12 |
12 |
$15.75 |
| D9211 |
|
839 |
776 |
$2.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
170 |
158 |
$1.00 |
| D1999 |
|
229 |
195 |
$0.00 |