| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,989 |
3,139 |
$404K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,150 |
2,379 |
$241K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,719 |
461 |
$168K |
| D9999 |
Unspecified adjunctive procedure, by report |
372 |
355 |
$121K |
| D1120 |
Prophylaxis - child |
3,217 |
3,208 |
$120K |
| D1206 |
Topical application of fluoride varnish |
3,881 |
3,840 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,749 |
3,721 |
$87K |
| D1351 |
Sealant - per tooth |
4,277 |
966 |
$78K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,173 |
3,578 |
$76K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,174 |
771 |
$75K |
| D1110 |
Prophylaxis - adult |
2,890 |
2,854 |
$75K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
171 |
150 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,913 |
2,893 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,060 |
483 |
$54K |
| D4341 |
|
1,175 |
476 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
1,301 |
1,293 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,567 |
1,496 |
$38K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
471 |
198 |
$29K |
| D4910 |
|
614 |
579 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
5,272 |
5,178 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,905 |
1,892 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,269 |
4,351 |
$20K |
| D2330 |
|
437 |
197 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,945 |
1,923 |
$16K |
| D2950 |
|
294 |
249 |
$15K |
| D0603 |
|
1,349 |
1,349 |
$13K |
| D9920 |
|
424 |
407 |
$10K |
| D9420 |
|
269 |
252 |
$7K |
| D2932 |
|
42 |
12 |
$6K |
| D2332 |
|
73 |
52 |
$3K |
| D2335 |
|
47 |
29 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
251 |
250 |
$3K |
| D0330 |
Panoramic radiographic image |
89 |
89 |
$3K |
| D0602 |
|
254 |
254 |
$2K |
| D0601 |
|
213 |
213 |
$2K |
| D1353 |
|
141 |
33 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
36 |
36 |
$765.00 |
| D4346 |
|
13 |
13 |
$401.40 |
| D0270 |
|
54 |
52 |
$228.50 |