| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,944 |
4,002 |
$575K |
| D1120 |
Prophylaxis - child |
14,178 |
14,066 |
$403K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,618 |
1,116 |
$311K |
| D0120 |
Periodic oral evaluation - established patient |
16,095 |
15,962 |
$268K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,204 |
13,085 |
$262K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,242 |
1,729 |
$190K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,911 |
1,886 |
$169K |
| D1110 |
Prophylaxis - adult |
3,876 |
3,841 |
$146K |
| D9248 |
|
1,490 |
1,453 |
$143K |
| D1351 |
Sealant - per tooth |
4,325 |
1,510 |
$123K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,701 |
796 |
$121K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,316 |
3,847 |
$115K |
| D0272 |
Bitewings - two radiographic images |
5,751 |
5,699 |
$98K |
| D0220 |
Intraoral - periapical first radiographic image |
8,463 |
8,336 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,443 |
6,883 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,771 |
2,745 |
$61K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
640 |
460 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,982 |
1,971 |
$57K |
| D1206 |
Topical application of fluoride varnish |
3,791 |
3,772 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,392 |
1,367 |
$32K |
| D0240 |
|
2,746 |
1,504 |
$31K |
| D9630 |
|
1,025 |
1,013 |
$19K |
| D9999 |
Unspecified adjunctive procedure, by report |
162 |
161 |
$14K |
| D3120 |
|
515 |
309 |
$9K |
| D9310 |
|
94 |
92 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
289 |
245 |
$7K |
| D9920 |
|
100 |
99 |
$5K |
| D0330 |
Panoramic radiographic image |
73 |
73 |
$842.28 |