| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29,667 |
17,268 |
$2.36M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,526 |
5,562 |
$1.79M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,031 |
12,465 |
$1.71M |
| D0120 |
Periodic oral evaluation - established patient |
64,185 |
62,852 |
$1.67M |
| D1120 |
Prophylaxis - child |
48,298 |
47,194 |
$1.32M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25,964 |
25,037 |
$1.15M |
| D1206 |
Topical application of fluoride varnish |
60,520 |
59,030 |
$991K |
| D1110 |
Prophylaxis - adult |
25,816 |
25,216 |
$988K |
| D0220 |
Intraoral - periapical first radiographic image |
45,684 |
44,447 |
$687K |
| D0330 |
Panoramic radiographic image |
10,557 |
10,281 |
$543K |
| D1351 |
Sealant - per tooth |
17,931 |
8,107 |
$489K |
| D0230 |
Intraoral - periapical each additional radiographic image |
41,749 |
21,928 |
$462K |
| D0272 |
Bitewings - two radiographic images |
24,195 |
23,632 |
$440K |
| D0274 |
Bitewings - four radiographic images |
12,857 |
12,514 |
$406K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,064 |
2,625 |
$404K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,310 |
7,118 |
$321K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,809 |
12,606 |
$201K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,180 |
1,344 |
$134K |
| D9420 |
|
828 |
768 |
$96K |
| D0140 |
Limited oral evaluation - problem focused |
2,569 |
2,473 |
$95K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
490 |
424 |
$64K |
| D2330 |
|
563 |
398 |
$37K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,035 |
1,044 |
$37K |
| D2934 |
|
75 |
27 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
139 |
104 |
$13K |
| D2332 |
|
69 |
49 |
$7K |
| D0350 |
|
3,897 |
3,784 |
$2K |
| D2140 |
|
16 |
12 |
$1K |
| D1354 |
|
23 |
13 |
$207.85 |
| D1999 |
|
277 |
275 |
$0.00 |
| D0171 |
|
230 |
219 |
$0.00 |