| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,125 |
5,991 |
$1.22M |
| D0120 |
Periodic oral evaluation - established patient |
21,172 |
20,263 |
$528K |
| D1110 |
Prophylaxis - adult |
13,674 |
12,991 |
$496K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,838 |
2,432 |
$469K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,958 |
3,614 |
$459K |
| D0274 |
Bitewings - four radiographic images |
10,802 |
10,103 |
$308K |
| D1351 |
Sealant - per tooth |
11,736 |
2,880 |
$306K |
| D0330 |
Panoramic radiographic image |
6,994 |
6,406 |
$283K |
| D1120 |
Prophylaxis - child |
10,815 |
10,316 |
$280K |
| D0220 |
Intraoral - periapical first radiographic image |
19,912 |
18,426 |
$275K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,910 |
6,325 |
$274K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,061 |
16,264 |
$263K |
| D1206 |
Topical application of fluoride varnish |
14,750 |
14,117 |
$233K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,309 |
4,603 |
$223K |
| D0140 |
Limited oral evaluation - problem focused |
4,213 |
3,856 |
$145K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,341 |
1,158 |
$139K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,158 |
683 |
$120K |
| D4355 |
|
1,819 |
1,702 |
$112K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
814 |
357 |
$101K |
| D0272 |
Bitewings - two radiographic images |
5,383 |
5,133 |
$92K |
| D2394 |
|
416 |
296 |
$60K |
| D2332 |
|
476 |
287 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,737 |
2,515 |
$42K |
| D2331 |
|
362 |
256 |
$28K |
| D4341 |
|
325 |
129 |
$27K |
| D2330 |
|
408 |
247 |
$25K |
| D2335 |
|
150 |
102 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
144 |
87 |
$11K |
| D4342 |
|
94 |
49 |
$5K |
| D4346 |
|
142 |
136 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$878.25 |