| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,967 |
6,106 |
$1.19M |
| D1120 |
Prophylaxis - child |
22,534 |
22,523 |
$900K |
| D0120 |
Periodic oral evaluation - established patient |
25,108 |
25,105 |
$808K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,208 |
1,740 |
$797K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,264 |
4,584 |
$638K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,828 |
17,824 |
$465K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,381 |
2,539 |
$367K |
| D0272 |
Bitewings - two radiographic images |
11,348 |
11,338 |
$275K |
| D1206 |
Topical application of fluoride varnish |
6,541 |
6,532 |
$177K |
| D1110 |
Prophylaxis - adult |
3,337 |
3,336 |
$161K |
| D0140 |
Limited oral evaluation - problem focused |
2,562 |
2,538 |
$154K |
| D2331 |
|
1,362 |
917 |
$134K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
832 |
697 |
$121K |
| D9420 |
|
843 |
841 |
$120K |
| D2330 |
|
1,405 |
879 |
$108K |
| D1354 |
|
3,142 |
1,513 |
$81K |
| D1351 |
Sealant - per tooth |
2,389 |
960 |
$72K |
| D0330 |
Panoramic radiographic image |
1,011 |
1,011 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
3,391 |
3,370 |
$62K |
| D9310 |
|
854 |
854 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,001 |
1,001 |
$58K |
| D2332 |
|
458 |
274 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,460 |
1,394 |
$46K |
| D0240 |
|
2,633 |
1,695 |
$44K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
335 |
200 |
$42K |
| D2335 |
|
99 |
42 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
357 |
357 |
$14K |
| D0274 |
Bitewings - four radiographic images |
149 |
148 |
$6K |
| D9110 |
|
50 |
50 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,572 |
2,537 |
$0.00 |
| D9995 |
|
13 |
12 |
$0.00 |