| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21,516 |
9,998 |
$2.45M |
| D1120 |
Prophylaxis - child |
30,201 |
29,404 |
$1.14M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,587 |
2,159 |
$1.03M |
| D0120 |
Periodic oral evaluation - established patient |
31,412 |
30,713 |
$1.01M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,975 |
4,670 |
$706K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17,049 |
15,035 |
$690K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,448 |
3,662 |
$677K |
| D1351 |
Sealant - per tooth |
18,091 |
6,341 |
$582K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,243 |
8,813 |
$549K |
| D1110 |
Prophylaxis - adult |
8,848 |
8,588 |
$483K |
| D1206 |
Topical application of fluoride varnish |
19,131 |
18,547 |
$386K |
| D0272 |
Bitewings - two radiographic images |
13,473 |
13,016 |
$358K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,844 |
17,465 |
$320K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,178 |
1,523 |
$296K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,482 |
1,178 |
$251K |
| D0330 |
Panoramic radiographic image |
4,221 |
4,008 |
$180K |
| D0274 |
Bitewings - four radiographic images |
5,339 |
5,158 |
$179K |
| D0140 |
Limited oral evaluation - problem focused |
1,653 |
1,582 |
$78K |
| D2332 |
|
485 |
296 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
3,869 |
3,618 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,071 |
1,500 |
$37K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
15 |
15 |
$20K |
| D2929 |
|
78 |
26 |
$19K |
| D0240 |
|
855 |
437 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
183 |
181 |
$8K |
| D1510 |
|
41 |
37 |
$7K |
| D9420 |
|
74 |
70 |
$4K |
| D2330 |
|
19 |
13 |
$2K |
| D9986 |
|
1,961 |
1,881 |
$0.00 |
| D9987 |
|
2,711 |
2,617 |
$0.00 |