| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,843 |
4,996 |
$937K |
| D1120 |
Prophylaxis - child |
22,425 |
22,390 |
$904K |
| D0120 |
Periodic oral evaluation - established patient |
21,326 |
21,296 |
$655K |
| D1206 |
Topical application of fluoride varnish |
24,660 |
24,627 |
$646K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,837 |
1,618 |
$544K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,319 |
3,268 |
$393K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,604 |
10,911 |
$292K |
| D0210 |
Intraoral - complete series of radiographic images |
4,166 |
4,104 |
$280K |
| D0220 |
Intraoral - periapical first radiographic image |
13,783 |
13,557 |
$235K |
| D1351 |
Sealant - per tooth |
7,569 |
2,717 |
$229K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,841 |
3,839 |
$217K |
| D0240 |
|
10,511 |
5,544 |
$211K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,432 |
1,537 |
$207K |
| D1110 |
Prophylaxis - adult |
3,585 |
3,581 |
$170K |
| D9310 |
|
2,238 |
2,237 |
$170K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,194 |
835 |
$169K |
| D0140 |
Limited oral evaluation - problem focused |
2,500 |
2,474 |
$139K |
| D0274 |
Bitewings - four radiographic images |
4,187 |
4,184 |
$138K |
| D0272 |
Bitewings - two radiographic images |
4,232 |
4,227 |
$104K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
756 |
483 |
$95K |
| D2332 |
|
762 |
472 |
$93K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,514 |
1,511 |
$60K |
| D2950 |
|
271 |
216 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,406 |
1,406 |
$40K |
| D2710 |
|
62 |
50 |
$39K |
| D9420 |
|
253 |
253 |
$38K |
| D2940 |
|
585 |
379 |
$38K |
| D1510 |
|
130 |
92 |
$28K |
| D2390 |
|
115 |
45 |
$24K |
| D2330 |
|
207 |
127 |
$18K |
| D0330 |
Panoramic radiographic image |
181 |
180 |
$11K |
| D1354 |
|
235 |
93 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$6K |
| D2331 |
|
14 |
12 |
$1K |