| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
40,223 |
24,960 |
$4.16M |
| D0120 |
Periodic oral evaluation - established patient |
73,314 |
70,099 |
$1.86M |
| D1120 |
Prophylaxis - child |
52,021 |
49,931 |
$1.39M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30,731 |
28,196 |
$1.32M |
| D1208 |
Topical application of fluoride, excluding varnish |
72,834 |
69,579 |
$1.18M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
8,152 |
6,268 |
$1.00M |
| D1110 |
Prophylaxis - adult |
25,696 |
24,347 |
$952K |
| D7140 |
Extraction, erupted tooth or exposed root |
15,048 |
8,958 |
$936K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,748 |
8,725 |
$917K |
| D1351 |
Sealant - per tooth |
32,145 |
9,349 |
$892K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,371 |
2,881 |
$607K |
| D0274 |
Bitewings - four radiographic images |
13,843 |
13,111 |
$430K |
| D0272 |
Bitewings - two radiographic images |
22,442 |
21,517 |
$405K |
| D0330 |
Panoramic radiographic image |
6,395 |
6,186 |
$367K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,489 |
1,753 |
$195K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,268 |
4,051 |
$182K |
| D0140 |
Limited oral evaluation - problem focused |
4,067 |
3,848 |
$146K |
| D0220 |
Intraoral - periapical first radiographic image |
9,672 |
9,024 |
$140K |
| D0240 |
|
6,793 |
4,286 |
$105K |
| D1206 |
Topical application of fluoride varnish |
3,664 |
3,516 |
$58K |
| D2330 |
|
253 |
198 |
$17K |
| D1510 |
|
79 |
75 |
$15K |
| D2332 |
|
97 |
75 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
534 |
281 |
$6K |