| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,526 |
5,824 |
$1.38M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
9,939 |
4,497 |
$1.31M |
| D1120 |
Prophylaxis - child |
15,229 |
15,084 |
$451K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,641 |
1,406 |
$428K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,432 |
1,567 |
$391K |
| D0120 |
Periodic oral evaluation - established patient |
18,473 |
18,288 |
$383K |
| D0274 |
Bitewings - four radiographic images |
10,762 |
10,691 |
$318K |
| D1206 |
Topical application of fluoride varnish |
19,267 |
19,029 |
$314K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,502 |
1,006 |
$299K |
| D9248 |
|
2,178 |
2,060 |
$285K |
| D1110 |
Prophylaxis - adult |
6,386 |
6,302 |
$282K |
| D0330 |
Panoramic radiographic image |
5,477 |
5,439 |
$263K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,907 |
12,075 |
$249K |
| D0220 |
Intraoral - periapical first radiographic image |
16,445 |
15,941 |
$245K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,627 |
1,304 |
$244K |
| D0140 |
Limited oral evaluation - problem focused |
5,433 |
5,280 |
$159K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,607 |
5,345 |
$149K |
| D2335 |
|
1,001 |
500 |
$117K |
| D1351 |
Sealant - per tooth |
4,909 |
1,479 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,143 |
3,088 |
$93K |
| D2332 |
|
763 |
432 |
$78K |
| D7111 |
|
1,211 |
607 |
$69K |
| D2394 |
|
350 |
225 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,690 |
2,690 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
591 |
330 |
$34K |
| D1320 |
|
772 |
757 |
$27K |
| D7250 |
|
201 |
61 |
$24K |
| D0601 |
|
2,456 |
2,370 |
$22K |
| D5130 |
|
24 |
24 |
$20K |
| D7240 |
Removal of impacted tooth - completely bony |
79 |
27 |
$17K |
| D5140 |
|
13 |
13 |
$11K |
| D0240 |
|
516 |
420 |
$10K |
| D0603 |
|
847 |
833 |
$8K |
| D0602 |
|
724 |
691 |
$7K |
| D0272 |
Bitewings - two radiographic images |
203 |
203 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$745.10 |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
26 |
$576.53 |