| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,919 |
1,859 |
$348K |
| D1120 |
Prophylaxis - child |
5,632 |
5,495 |
$237K |
| D0120 |
Periodic oral evaluation - established patient |
6,049 |
5,893 |
$175K |
| D1351 |
Sealant - per tooth |
4,944 |
1,573 |
$163K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,233 |
6,073 |
$142K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
672 |
532 |
$100K |
| D1110 |
Prophylaxis - adult |
1,185 |
1,146 |
$68K |
| D0330 |
Panoramic radiographic image |
1,127 |
1,098 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
487 |
387 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
844 |
821 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
276 |
103 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
350 |
194 |
$36K |
| D0272 |
Bitewings - two radiographic images |
2,090 |
2,040 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,372 |
1,338 |
$30K |
| D1330 |
|
3,801 |
3,706 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
501 |
481 |
$22K |
| D1206 |
Topical application of fluoride varnish |
800 |
779 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
802 |
776 |
$7K |
| D3120 |
|
187 |
142 |
$6K |
| D0240 |
|
348 |
338 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
87 |
50 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
119 |
118 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
40 |
38 |
$342.00 |