| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,256 |
2,946 |
$1.14M |
| D1120 |
Prophylaxis - child |
15,508 |
14,924 |
$811K |
| D0120 |
Periodic oral evaluation - established patient |
19,015 |
17,802 |
$755K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,563 |
6,566 |
$516K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,175 |
817 |
$500K |
| D1110 |
Prophylaxis - adult |
6,714 |
6,508 |
$473K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,017 |
1,551 |
$471K |
| D1351 |
Sealant - per tooth |
10,692 |
2,119 |
$457K |
| D1206 |
Topical application of fluoride varnish |
12,500 |
11,902 |
$391K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,969 |
1,406 |
$345K |
| D0272 |
Bitewings - two radiographic images |
8,768 |
8,432 |
$316K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,908 |
8,733 |
$279K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,479 |
792 |
$232K |
| D0274 |
Bitewings - four radiographic images |
4,412 |
4,177 |
$221K |
| D9248 |
|
767 |
745 |
$197K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,967 |
2,716 |
$179K |
| D0330 |
Panoramic radiographic image |
2,170 |
1,950 |
$164K |
| D2140 |
|
930 |
577 |
$117K |
| D0220 |
Intraoral - periapical first radiographic image |
3,300 |
3,095 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,554 |
1,449 |
$69K |
| D0240 |
|
3,738 |
1,704 |
$57K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
290 |
160 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
179 |
131 |
$46K |
| D2390 |
|
87 |
36 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
479 |
462 |
$29K |
| D0160 |
|
145 |
118 |
$15K |
| D2330 |
|
96 |
54 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
252 |
235 |
$13K |
| D1550 |
|
65 |
64 |
$5K |
| D1510 |
|
15 |
15 |
$4K |
| D0270 |
|
84 |
81 |
$2K |
| D0170 |
|
13 |
12 |
$798.20 |
| D0210 |
Intraoral - complete series of radiographic images |
20 |
16 |
$456.56 |
| D1999 |
|
3,114 |
2,328 |
$0.00 |
| D0603 |
|
11,877 |
11,347 |
$0.00 |
| D0601 |
|
1,446 |
1,423 |
$0.00 |
| D0602 |
|
8,818 |
8,531 |
$0.00 |
| D1330 |
|
13,629 |
13,091 |
$0.00 |
| D9420 |
|
105 |
83 |
$0.00 |