| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,850 |
3,333 |
$643K |
| D0120 |
Periodic oral evaluation - established patient |
25,170 |
25,127 |
$596K |
| D1110 |
Prophylaxis - adult |
10,984 |
10,966 |
$505K |
| D1120 |
Prophylaxis - child |
15,217 |
15,191 |
$505K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,880 |
11,842 |
$337K |
| D1351 |
Sealant - per tooth |
8,859 |
3,757 |
$316K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,134 |
7,852 |
$252K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,292 |
19,277 |
$220K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,886 |
1,428 |
$198K |
| D0220 |
Intraoral - periapical first radiographic image |
14,066 |
13,923 |
$173K |
| D0274 |
Bitewings - four radiographic images |
5,640 |
5,632 |
$165K |
| D1206 |
Topical application of fluoride varnish |
6,134 |
6,107 |
$135K |
| D0330 |
Panoramic radiographic image |
1,831 |
1,821 |
$96K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
687 |
520 |
$85K |
| D0272 |
Bitewings - two radiographic images |
3,259 |
3,256 |
$67K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
649 |
508 |
$66K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
321 |
283 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
2,072 |
2,055 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
397 |
290 |
$38K |
| D3120 |
|
906 |
750 |
$33K |
| D7111 |
|
496 |
335 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
828 |
822 |
$28K |
| D2140 |
|
279 |
238 |
$23K |
| D9310 |
|
536 |
536 |
$22K |
| D8670 |
Periodic orthodontic treatment visit |
145 |
145 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
208 |
165 |
$18K |
| D1353 |
|
181 |
75 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
151 |
151 |
$6K |
| D0350 |
|
69 |
69 |
$2K |
| D2160 |
|
14 |
13 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
55 |
55 |
$2K |
| D8660 |
|
15 |
15 |
$645.00 |