| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,923 |
2,305 |
$235K |
| D0120 |
Periodic oral evaluation - established patient |
6,540 |
6,473 |
$146K |
| D9920 |
|
4,170 |
3,168 |
$108K |
| D1120 |
Prophylaxis - child |
4,857 |
4,772 |
$107K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,272 |
7,133 |
$103K |
| D1110 |
Prophylaxis - adult |
2,441 |
2,413 |
$85K |
| D1351 |
Sealant - per tooth |
3,888 |
1,316 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,425 |
1,060 |
$69K |
| D0272 |
Bitewings - two radiographic images |
6,338 |
6,244 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
909 |
649 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
7,131 |
6,942 |
$55K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
510 |
315 |
$42K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
310 |
202 |
$27K |
| D2331 |
|
386 |
285 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
725 |
682 |
$23K |
| D0330 |
Panoramic radiographic image |
594 |
571 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
1,227 |
1,141 |
$23K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
520 |
309 |
$22K |
| D9999 |
Unspecified adjunctive procedure, by report |
787 |
761 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
313 |
222 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,538 |
6,355 |
$15K |
| D2332 |
|
31 |
25 |
$2K |
| D1999 |
|
37 |
36 |
$20.00 |