| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21,092 |
12,954 |
$2.58M |
| D1120 |
Prophylaxis - child |
49,741 |
48,884 |
$2.15M |
| D1351 |
Sealant - per tooth |
59,969 |
13,396 |
$2.03M |
| D0120 |
Periodic oral evaluation - established patient |
63,555 |
62,474 |
$1.86M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,150 |
4,503 |
$1.59M |
| D1208 |
Topical application of fluoride, excluding varnish |
52,636 |
51,708 |
$1.19M |
| D1110 |
Prophylaxis - adult |
16,283 |
16,013 |
$970K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,243 |
5,143 |
$686K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,728 |
3,407 |
$610K |
| D1206 |
Topical application of fluoride varnish |
16,875 |
16,614 |
$417K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
21,327 |
19,634 |
$391K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,819 |
1,355 |
$280K |
| D0330 |
Panoramic radiographic image |
6,442 |
6,298 |
$271K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,053 |
4,954 |
$263K |
| D0272 |
Bitewings - two radiographic images |
14,551 |
14,263 |
$220K |
| D1330 |
|
36,605 |
35,582 |
$218K |
| D0274 |
Bitewings - four radiographic images |
7,506 |
7,367 |
$167K |
| D0140 |
Limited oral evaluation - problem focused |
1,274 |
1,238 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
4,446 |
4,338 |
$42K |
| D3120 |
|
1,137 |
798 |
$39K |
| D2335 |
|
202 |
73 |
$31K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
217 |
109 |
$13K |
| D0240 |
|
453 |
445 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
132 |
129 |
$2K |
| D9420 |
|
63 |
63 |
$945.00 |