| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,731 |
4,259 |
$1.11M |
| D1120 |
Prophylaxis - child |
18,495 |
17,968 |
$741K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,642 |
3,475 |
$708K |
| D0120 |
Periodic oral evaluation - established patient |
22,657 |
22,038 |
$653K |
| D1206 |
Topical application of fluoride varnish |
17,888 |
17,423 |
$452K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,075 |
2,149 |
$328K |
| D1110 |
Prophylaxis - adult |
4,710 |
4,567 |
$262K |
| D0272 |
Bitewings - two radiographic images |
9,036 |
8,778 |
$257K |
| D9420 |
|
1,357 |
1,294 |
$246K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,196 |
6,578 |
$228K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,698 |
4,492 |
$210K |
| D1351 |
Sealant - per tooth |
6,443 |
1,767 |
$192K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,159 |
407 |
$180K |
| D4910 |
|
1,722 |
1,634 |
$101K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
778 |
396 |
$76K |
| D0330 |
Panoramic radiographic image |
531 |
515 |
$37K |
| D9920 |
|
246 |
226 |
$16K |
| D0240 |
|
487 |
388 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
204 |
200 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
392 |
347 |
$6K |