| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,809 |
7,526 |
$1.56M |
| D0120 |
Periodic oral evaluation - established patient |
45,136 |
44,234 |
$934K |
| D1120 |
Prophylaxis - child |
28,249 |
27,682 |
$837K |
| D1110 |
Prophylaxis - adult |
17,816 |
17,459 |
$789K |
| D1208 |
Topical application of fluoride, excluding varnish |
43,794 |
42,953 |
$648K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,662 |
1,808 |
$493K |
| D0330 |
Panoramic radiographic image |
8,664 |
8,584 |
$410K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,490 |
3,006 |
$355K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,669 |
837 |
$309K |
| D0274 |
Bitewings - four radiographic images |
9,634 |
9,440 |
$284K |
| D0272 |
Bitewings - two radiographic images |
14,598 |
14,342 |
$259K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,105 |
8,546 |
$237K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,306 |
1,416 |
$199K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,109 |
749 |
$186K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,015 |
2,027 |
$176K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,022 |
3,912 |
$120K |
| D0140 |
Limited oral evaluation - problem focused |
3,571 |
3,498 |
$106K |
| D0220 |
Intraoral - periapical first radiographic image |
5,995 |
5,877 |
$88K |
| D0601 |
|
4,243 |
3,627 |
$39K |
| D1351 |
Sealant - per tooth |
1,451 |
385 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,033 |
1,991 |
$30K |
| D2140 |
|
524 |
403 |
$29K |
| D2332 |
|
158 |
75 |
$16K |
| D2160 |
|
119 |
94 |
$13K |
| D0602 |
|
998 |
826 |
$9K |
| D0603 |
|
309 |
267 |
$3K |
| D1206 |
Topical application of fluoride varnish |
111 |
111 |
$2K |