| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,927 |
7,294 |
$676K |
| D1120 |
Prophylaxis - child |
16,236 |
16,217 |
$635K |
| D0120 |
Periodic oral evaluation - established patient |
21,491 |
21,472 |
$526K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,124 |
3,326 |
$282K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,420 |
2,906 |
$270K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,281 |
4,222 |
$249K |
| D0272 |
Bitewings - two radiographic images |
17,389 |
17,369 |
$245K |
| D1110 |
Prophylaxis - adult |
5,521 |
5,516 |
$245K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,046 |
4,081 |
$220K |
| D1206 |
Topical application of fluoride varnish |
7,143 |
7,134 |
$184K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,367 |
14,355 |
$181K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,424 |
1,214 |
$151K |
| D0220 |
Intraoral - periapical first radiographic image |
12,663 |
12,506 |
$139K |
| D1351 |
Sealant - per tooth |
3,610 |
3,137 |
$126K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
973 |
903 |
$82K |
| D2140 |
|
1,304 |
1,149 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,216 |
10,157 |
$54K |
| D2160 |
|
395 |
375 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,049 |
1,048 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,014 |
1,008 |
$13K |
| D2331 |
|
81 |
64 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
53 |
53 |
$4K |
| D1999 |
|
81 |
81 |
$4K |
| D9110 |
|
149 |
148 |
$4K |
| D0273 |
|
193 |
192 |
$4K |
| D2330 |
|
30 |
24 |
$1K |
| D0601 |
|
1,045 |
1,045 |
$1K |
| D0603 |
|
914 |
914 |
$914.00 |
| D0602 |
|
862 |
862 |
$860.00 |
| D9996 |
|
46 |
46 |
$0.00 |