| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,916 |
2,299 |
$640K |
| D1120 |
Prophylaxis - child |
6,210 |
5,816 |
$197K |
| D9248 |
|
1,200 |
1,079 |
$170K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,200 |
1,348 |
$159K |
| D1351 |
Sealant - per tooth |
5,808 |
1,867 |
$158K |
| D0120 |
Periodic oral evaluation - established patient |
6,349 |
5,879 |
$157K |
| D1206 |
Topical application of fluoride varnish |
5,358 |
4,940 |
$116K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,024 |
3,542 |
$108K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
712 |
336 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,231 |
668 |
$91K |
| D0272 |
Bitewings - two radiographic images |
3,617 |
3,387 |
$83K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
316 |
214 |
$54K |
| D1110 |
Prophylaxis - adult |
1,133 |
1,039 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,175 |
1,097 |
$43K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
427 |
203 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,893 |
1,805 |
$34K |
| D3120 |
|
819 |
498 |
$26K |
| D0330 |
Panoramic radiographic image |
352 |
339 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
185 |
173 |
$7K |
| D2332 |
|
50 |
26 |
$6K |
| D0240 |
|
490 |
255 |
$6K |
| D2330 |
|
64 |
40 |
$5K |
| D0274 |
Bitewings - four radiographic images |
105 |
97 |
$4K |
| D1310 |
|
85 |
82 |
$3K |