| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,169 |
2,007 |
$413K |
| D1120 |
Prophylaxis - child |
12,124 |
11,973 |
$407K |
| D0120 |
Periodic oral evaluation - established patient |
14,335 |
14,170 |
$339K |
| D1206 |
Topical application of fluoride varnish |
15,771 |
15,576 |
$300K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,581 |
1,674 |
$266K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,066 |
10,900 |
$223K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,390 |
5,146 |
$169K |
| D0220 |
Intraoral - periapical first radiographic image |
13,339 |
13,087 |
$167K |
| D1110 |
Prophylaxis - adult |
3,227 |
3,213 |
$152K |
| D0272 |
Bitewings - two radiographic images |
6,070 |
5,988 |
$126K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,038 |
400 |
$124K |
| D1351 |
Sealant - per tooth |
3,368 |
1,263 |
$120K |
| D7140 |
Extraction, erupted tooth or exposed root |
523 |
327 |
$51K |
| D0330 |
Panoramic radiographic image |
1,005 |
990 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,581 |
1,576 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,144 |
1,132 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,255 |
1,235 |
$42K |
| D7111 |
|
228 |
155 |
$14K |
| D9310 |
|
159 |
158 |
$6K |
| D4346 |
|
51 |
49 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
20 |
12 |
$2K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$1K |
| D0350 |
|
16 |
12 |
$795.08 |
| D9219 |
|
13 |
13 |
$518.83 |