| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,384 |
2,488 |
$524K |
| D1120 |
Prophylaxis - child |
10,487 |
10,462 |
$412K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,736 |
2,179 |
$329K |
| D0120 |
Periodic oral evaluation - established patient |
10,048 |
10,023 |
$310K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,895 |
10,871 |
$274K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,256 |
1,790 |
$271K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,420 |
894 |
$266K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,810 |
1,140 |
$222K |
| D1351 |
Sealant - per tooth |
5,741 |
1,399 |
$175K |
| D0272 |
Bitewings - two radiographic images |
6,200 |
6,185 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,651 |
1,650 |
$93K |
| D1110 |
Prophylaxis - adult |
1,728 |
1,726 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
3,179 |
3,152 |
$57K |
| D9248 |
|
767 |
766 |
$47K |
| D0240 |
|
1,595 |
816 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
195 |
145 |
$29K |
| D0330 |
Panoramic radiographic image |
308 |
308 |
$21K |
| D0274 |
Bitewings - four radiographic images |
483 |
483 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,285 |
814 |
$17K |
| D2331 |
|
132 |
70 |
$13K |
| D2335 |
|
60 |
31 |
$11K |
| D1510 |
|
46 |
42 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
165 |
164 |
$9K |
| D2332 |
|
24 |
15 |
$3K |
| D3110 |
|
34 |
33 |
$1K |
| D2330 |
|
17 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,170 |
4,038 |
$0.00 |