| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,522 |
6,104 |
$861K |
| D0120 |
Periodic oral evaluation - established patient |
31,188 |
29,558 |
$782K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,783 |
13,184 |
$621K |
| D1120 |
Prophylaxis - child |
21,900 |
20,768 |
$576K |
| D1208 |
Topical application of fluoride, excluding varnish |
31,336 |
29,692 |
$501K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,819 |
4,515 |
$441K |
| D1110 |
Prophylaxis - adult |
11,301 |
10,690 |
$417K |
| D1351 |
Sealant - per tooth |
11,182 |
4,061 |
$306K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,589 |
3,035 |
$277K |
| D0330 |
Panoramic radiographic image |
4,132 |
3,890 |
$229K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,520 |
881 |
$213K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,554 |
1,225 |
$196K |
| D0274 |
Bitewings - four radiographic images |
6,100 |
5,763 |
$188K |
| D0272 |
Bitewings - two radiographic images |
10,169 |
9,656 |
$179K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,893 |
1,772 |
$80K |
| D0240 |
|
4,916 |
2,648 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
5,304 |
4,939 |
$76K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
898 |
601 |
$73K |
| D0140 |
Limited oral evaluation - problem focused |
1,699 |
1,604 |
$61K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
268 |
232 |
$27K |
| D2934 |
|
137 |
58 |
$24K |
| D2140 |
|
267 |
240 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,032 |
958 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
622 |
358 |
$7K |