| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,273 |
5,753 |
$973K |
| D1120 |
Prophylaxis - child |
24,483 |
23,745 |
$670K |
| D0120 |
Periodic oral evaluation - established patient |
24,133 |
23,448 |
$630K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,257 |
12,461 |
$590K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,464 |
26,650 |
$460K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,079 |
3,469 |
$406K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,604 |
1,712 |
$369K |
| D1351 |
Sealant - per tooth |
10,549 |
3,028 |
$299K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,408 |
2,128 |
$215K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,541 |
4,363 |
$200K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,506 |
6,337 |
$200K |
| D0220 |
Intraoral - periapical first radiographic image |
12,187 |
11,683 |
$184K |
| D1110 |
Prophylaxis - adult |
4,322 |
4,198 |
$166K |
| D0140 |
Limited oral evaluation - problem focused |
3,577 |
3,448 |
$133K |
| D0240 |
|
7,841 |
4,223 |
$127K |
| D0272 |
Bitewings - two radiographic images |
6,387 |
6,189 |
$118K |
| D0330 |
Panoramic radiographic image |
1,065 |
1,037 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,604 |
1,559 |
$52K |
| D0170 |
|
1,040 |
999 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
193 |
150 |
$26K |
| D2332 |
|
204 |
137 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,341 |
1,304 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
191 |
165 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
499 |
418 |
$15K |
| D1354 |
|
1,679 |
501 |
$10K |
| D9420 |
|
37 |
24 |
$3K |
| D2330 |
|
33 |
28 |
$2K |
| D1310 |
|
206 |
206 |
$0.00 |
| D1330 |
|
229 |
229 |
$0.00 |