| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,638 |
2,794 |
$530K |
| D1120 |
Prophylaxis - child |
7,132 |
6,859 |
$358K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,832 |
1,815 |
$214K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,711 |
2,613 |
$207K |
| D1110 |
Prophylaxis - adult |
2,130 |
2,037 |
$194K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,585 |
1,047 |
$127K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
760 |
584 |
$126K |
| D0330 |
Panoramic radiographic image |
1,665 |
1,596 |
$85K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
359 |
280 |
$72K |
| D0240 |
|
1,781 |
1,652 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
6,631 |
6,357 |
$54K |
| D1351 |
Sealant - per tooth |
4,168 |
1,260 |
$52K |
| D9920 |
|
1,976 |
1,723 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,737 |
4,591 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
539 |
506 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
363 |
282 |
$13K |
| D0272 |
Bitewings - two radiographic images |
5,594 |
5,365 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,020 |
6,730 |
$12K |
| D2332 |
|
102 |
66 |
$9K |
| D0274 |
Bitewings - four radiographic images |
2,027 |
1,938 |
$8K |
| D1206 |
Topical application of fluoride varnish |
1,783 |
1,725 |
$7K |
| D1330 |
|
9,100 |
8,758 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
760 |
714 |
$5K |
| D1510 |
|
37 |
28 |
$1K |
| D2330 |
|
16 |
14 |
$856.60 |
| D2331 |
|
14 |
12 |
$352.00 |
| D9310 |
|
46 |
44 |
$240.00 |