| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,485 |
3,186 |
$314K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,812 |
1,562 |
$263K |
| D1120 |
Prophylaxis - child |
12,303 |
12,011 |
$227K |
| D0120 |
Periodic oral evaluation - established patient |
11,453 |
11,178 |
$141K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,489 |
2,077 |
$116K |
| D0272 |
Bitewings - two radiographic images |
10,651 |
10,351 |
$105K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,692 |
11,423 |
$103K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,628 |
1,437 |
$96K |
| D2390 |
|
788 |
254 |
$78K |
| D1351 |
Sealant - per tooth |
5,476 |
1,831 |
$58K |
| D9248 |
|
1,586 |
1,491 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,990 |
1,949 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,555 |
4,289 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
648 |
462 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
2,036 |
1,924 |
$34K |
| D2332 |
|
565 |
338 |
$33K |
| D1110 |
Prophylaxis - adult |
1,135 |
1,118 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
3,863 |
3,526 |
$26K |
| D1354 |
|
2,814 |
1,222 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,217 |
1,196 |
$18K |
| D9310 |
|
646 |
598 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
311 |
182 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,976 |
1,614 |
$11K |
| D3120 |
|
842 |
441 |
$9K |
| D2330 |
|
221 |
143 |
$9K |
| D0330 |
Panoramic radiographic image |
709 |
674 |
$9K |
| D3240 |
|
170 |
101 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
17 |
$967.81 |
| D1206 |
Topical application of fluoride varnish |
90 |
87 |
$121.65 |