| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,550 |
7,844 |
$984K |
| D0120 |
Periodic oral evaluation - established patient |
32,263 |
30,863 |
$839K |
| D1120 |
Prophylaxis - child |
29,612 |
28,252 |
$674K |
| D1206 |
Topical application of fluoride varnish |
34,220 |
32,738 |
$650K |
| D2929 |
|
2,283 |
960 |
$400K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,834 |
12,449 |
$317K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,697 |
3,106 |
$313K |
| D9999 |
Unspecified adjunctive procedure, by report |
8,242 |
7,917 |
$238K |
| D1351 |
Sealant - per tooth |
9,570 |
3,116 |
$217K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,904 |
2,204 |
$213K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,866 |
4,642 |
$191K |
| D1110 |
Prophylaxis - adult |
5,117 |
4,895 |
$189K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,214 |
2,308 |
$170K |
| D0272 |
Bitewings - two radiographic images |
12,606 |
12,063 |
$123K |
| D0330 |
Panoramic radiographic image |
3,122 |
2,962 |
$111K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,212 |
694 |
$95K |
| D2332 |
|
803 |
483 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
2,836 |
2,666 |
$59K |
| D1999 |
|
3,815 |
3,360 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
6,367 |
5,701 |
$48K |
| D0274 |
Bitewings - four radiographic images |
3,432 |
3,271 |
$47K |
| D0240 |
|
2,662 |
1,763 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,988 |
2,362 |
$13K |
| D9610 |
|
223 |
215 |
$8K |
| D2330 |
|
114 |
81 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
39 |
13 |
$2K |
| D9992 |
|
61 |
60 |
$885.00 |
| D0270 |
|
128 |
118 |
$752.40 |