| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,041 |
2,383 |
$895K |
| D1120 |
Prophylaxis - child |
9,281 |
8,937 |
$349K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,793 |
1,083 |
$305K |
| D0120 |
Periodic oral evaluation - established patient |
9,182 |
8,907 |
$298K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,543 |
11,130 |
$219K |
| D1354 |
|
6,151 |
1,465 |
$189K |
| D1351 |
Sealant - per tooth |
5,712 |
1,356 |
$186K |
| D0274 |
Bitewings - four radiographic images |
5,507 |
5,279 |
$183K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,745 |
812 |
$178K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,895 |
2,743 |
$165K |
| D1110 |
Prophylaxis - adult |
2,677 |
2,576 |
$146K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,148 |
2,918 |
$124K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
440 |
158 |
$101K |
| D0330 |
Panoramic radiographic image |
2,036 |
1,699 |
$76K |
| D0272 |
Bitewings - two radiographic images |
1,505 |
1,428 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
402 |
378 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,756 |
1,606 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,578 |
696 |
$14K |
| D3120 |
|
593 |
259 |
$14K |
| D9248 |
|
184 |
178 |
$13K |
| D2331 |
|
101 |
25 |
$10K |
| D0240 |
|
324 |
247 |
$4K |
| D1510 |
|
22 |
13 |
$3K |
| D2330 |
|
28 |
14 |
$3K |
| D9310 |
|
110 |
109 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
25 |
12 |
$2K |
| D0603 |
|
1,572 |
1,428 |
$0.00 |