| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,590 |
6,988 |
$842K |
| D1120 |
Prophylaxis - child |
20,572 |
19,665 |
$648K |
| D0120 |
Periodic oral evaluation - established patient |
26,484 |
25,245 |
$603K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,457 |
5,936 |
$585K |
| D1110 |
Prophylaxis - adult |
12,331 |
11,669 |
$493K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,207 |
19,939 |
$391K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,753 |
1,953 |
$390K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,582 |
10,467 |
$339K |
| D0274 |
Bitewings - four radiographic images |
13,016 |
12,479 |
$333K |
| D0220 |
Intraoral - periapical first radiographic image |
26,146 |
24,272 |
$304K |
| D0210 |
Intraoral - complete series of radiographic images |
5,916 |
5,641 |
$299K |
| D2740 |
Crown - porcelain/ceramic |
615 |
356 |
$256K |
| D1351 |
Sealant - per tooth |
10,622 |
3,415 |
$249K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,925 |
1,898 |
$222K |
| D1206 |
Topical application of fluoride varnish |
12,178 |
11,006 |
$216K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,396 |
21,146 |
$204K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,004 |
6,641 |
$189K |
| D0272 |
Bitewings - two radiographic images |
7,890 |
7,604 |
$135K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
344 |
242 |
$133K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,145 |
1,393 |
$119K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,286 |
866 |
$98K |
| D2332 |
|
962 |
576 |
$75K |
| D2950 |
|
859 |
540 |
$74K |
| D2330 |
|
719 |
427 |
$38K |
| D1510 |
|
276 |
232 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,130 |
1,071 |
$25K |
| D2335 |
|
205 |
128 |
$17K |
| D2331 |
|
137 |
97 |
$9K |
| D2394 |
|
99 |
77 |
$7K |
| D0330 |
Panoramic radiographic image |
193 |
184 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
107 |
82 |
$1K |
| D4346 |
|
16 |
12 |
$526.56 |
| D7111 |
|
442 |
295 |
$40.00 |
| D1330 |
|
137 |
133 |
$0.00 |