| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,217 |
3,078 |
$392K |
| D1120 |
Prophylaxis - child |
11,450 |
11,338 |
$320K |
| D1206 |
Topical application of fluoride varnish |
13,637 |
13,496 |
$230K |
| D0120 |
Periodic oral evaluation - established patient |
11,898 |
11,778 |
$196K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,943 |
2,021 |
$189K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,086 |
5,105 |
$185K |
| D1110 |
Prophylaxis - adult |
3,798 |
3,753 |
$135K |
| D9630 |
|
8,832 |
8,703 |
$119K |
| D1351 |
Sealant - per tooth |
3,823 |
1,290 |
$110K |
| D8670 |
Periodic orthodontic treatment visit |
269 |
269 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,840 |
2,785 |
$72K |
| D0272 |
Bitewings - two radiographic images |
4,037 |
3,996 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,223 |
790 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
676 |
505 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,395 |
2,349 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
1,521 |
1,309 |
$41K |
| D0330 |
Panoramic radiographic image |
664 |
653 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
4,206 |
4,085 |
$33K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
226 |
160 |
$28K |
| D9310 |
|
459 |
448 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,089 |
1,049 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,913 |
2,284 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
709 |
707 |
$14K |
| D9920 |
|
181 |
178 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
456 |
456 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
79 |
55 |
$5K |
| D8660 |
|
41 |
41 |
$4K |
| D2950 |
|
15 |
12 |
$2K |
| D0340 |
|
12 |
12 |
$864.24 |
| D3120 |
|
34 |
27 |
$625.94 |
| D9994 |
|
1,068 |
1,064 |
$0.00 |