| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,867 |
4,579 |
$701K |
| D0330 |
Panoramic radiographic image |
7,835 |
7,223 |
$459K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,612 |
2,223 |
$365K |
| D1110 |
Prophylaxis - adult |
9,527 |
8,860 |
$314K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,200 |
1,360 |
$302K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,945 |
8,149 |
$249K |
| D1120 |
Prophylaxis - child |
7,445 |
6,933 |
$243K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,223 |
1,517 |
$204K |
| D1351 |
Sealant - per tooth |
7,800 |
1,949 |
$204K |
| D0120 |
Periodic oral evaluation - established patient |
9,334 |
8,770 |
$201K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,133 |
1,855 |
$188K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,315 |
7,675 |
$151K |
| D0220 |
Intraoral - periapical first radiographic image |
9,231 |
8,648 |
$131K |
| D0274 |
Bitewings - four radiographic images |
4,812 |
4,496 |
$114K |
| D0272 |
Bitewings - two radiographic images |
2,896 |
2,765 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,881 |
1,535 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
1,532 |
1,414 |
$55K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
413 |
274 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,673 |
3,322 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,532 |
1,479 |
$37K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
412 |
270 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
831 |
752 |
$29K |
| D2331 |
|
106 |
66 |
$8K |
| D2332 |
|
90 |
56 |
$7K |
| D2330 |
|
93 |
62 |
$4K |
| D4341 |
|
33 |
12 |
$2K |
| D2394 |
|
13 |
13 |
$2K |
| D0470 |
|
12 |
12 |
$387.84 |
| D0270 |
|
14 |
14 |
$63.71 |
| D1999 |
|
406 |
346 |
$0.00 |