| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,127 |
1,628 |
$145K |
| D1120 |
Prophylaxis - child |
3,846 |
3,844 |
$123K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
953 |
665 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
6,344 |
6,280 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,645 |
2,643 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,278 |
1,000 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,412 |
2,412 |
$52K |
| D1110 |
Prophylaxis - adult |
1,139 |
1,139 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,412 |
5,401 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,676 |
1,676 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,412 |
1,411 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,661 |
2,660 |
$29K |
| D3240 |
|
146 |
122 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,788 |
1,788 |
$23K |
| D1351 |
Sealant - per tooth |
493 |
235 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
490 |
388 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
1,039 |
1,030 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
124 |
103 |
$10K |
| D2740 |
Crown - porcelain/ceramic |
15 |
14 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
52 |
44 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
186 |
186 |
$2K |
| D0273 |
|
92 |
92 |
$1K |
| D9110 |
|
40 |
40 |
$867.60 |
| D0340 |
|
12 |
12 |
$520.56 |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$478.72 |
| D8660 |
|
13 |
13 |
$377.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$294.00 |
| D0350 |
|
17 |
17 |
$177.99 |
| D0270 |
|
12 |
12 |
$125.64 |