| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18,912 |
7,013 |
$2.54M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,146 |
2,907 |
$1.30M |
| D1120 |
Prophylaxis - child |
22,503 |
21,809 |
$799K |
| D0120 |
Periodic oral evaluation - established patient |
24,885 |
24,183 |
$630K |
| D1206 |
Topical application of fluoride varnish |
29,246 |
28,323 |
$618K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,085 |
3,019 |
$603K |
| D1110 |
Prophylaxis - adult |
6,147 |
5,985 |
$316K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,283 |
7,891 |
$260K |
| D0272 |
Bitewings - two radiographic images |
10,421 |
10,110 |
$223K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,239 |
948 |
$191K |
| D2934 |
|
1,103 |
345 |
$186K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,736 |
769 |
$183K |
| D0330 |
Panoramic radiographic image |
2,805 |
2,679 |
$150K |
| D3230 |
|
1,239 |
352 |
$147K |
| D8660 |
|
923 |
889 |
$130K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,823 |
2,719 |
$113K |
| D0274 |
Bitewings - four radiographic images |
2,692 |
2,638 |
$85K |
| D9248 |
|
596 |
563 |
$81K |
| D1351 |
Sealant - per tooth |
1,373 |
450 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
1,007 |
969 |
$36K |
| D0340 |
|
548 |
543 |
$32K |
| D0470 |
|
514 |
512 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
661 |
661 |
$23K |
| D0350 |
|
525 |
515 |
$17K |
| D9420 |
|
140 |
137 |
$15K |
| D8670 |
Periodic orthodontic treatment visit |
84 |
84 |
$11K |
| D1510 |
|
47 |
36 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
504 |
458 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
24 |
$5K |
| D2330 |
|
20 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
145 |
145 |
$2K |
| D0240 |
|
47 |
47 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28 |
28 |
$953.10 |