| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,868 |
2,845 |
$857K |
| D9920 |
|
4,339 |
4,134 |
$697K |
| D9243 |
|
1,882 |
1,828 |
$562K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,864 |
1,175 |
$318K |
| D9248 |
|
2,045 |
1,930 |
$284K |
| D4212 |
|
2,264 |
1,174 |
$247K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,427 |
1,099 |
$166K |
| D1120 |
Prophylaxis - child |
4,332 |
4,164 |
$136K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,113 |
1,271 |
$133K |
| D1206 |
Topical application of fluoride varnish |
6,189 |
6,032 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
5,373 |
5,166 |
$117K |
| D0272 |
Bitewings - two radiographic images |
5,731 |
5,514 |
$109K |
| D1351 |
Sealant - per tooth |
3,092 |
1,039 |
$80K |
| D0330 |
Panoramic radiographic image |
1,480 |
1,431 |
$74K |
| D1110 |
Prophylaxis - adult |
1,461 |
1,419 |
$68K |
| D0602 |
|
3,006 |
2,936 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
802 |
777 |
$25K |
| D0603 |
|
2,436 |
2,372 |
$23K |
| D1310 |
|
583 |
572 |
$22K |
| D0425 |
|
473 |
465 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
430 |
405 |
$14K |
| D2335 |
|
107 |
65 |
$13K |
| D7510 |
|
100 |
66 |
$9K |
| D2332 |
|
49 |
26 |
$5K |
| D4355 |
|
54 |
53 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
114 |
110 |
$4K |
| D2330 |
|
49 |
25 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15 |
12 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21 |
13 |
$2K |
| D0601 |
|
162 |
160 |
$2K |
| D0350 |
|
37 |
37 |
$1K |
| D1320 |
|
29 |
29 |
$900.00 |
| D1330 |
|
33 |
32 |
$755.66 |
| D3120 |
|
18 |
13 |
$574.26 |
| D0220 |
Intraoral - periapical first radiographic image |
115 |
47 |
$217.13 |
| D1208 |
Topical application of fluoride, excluding varnish |
138 |
51 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
49 |
17 |
$0.00 |