| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,118 |
2,414 |
$311K |
| D0120 |
Periodic oral evaluation - established patient |
8,124 |
8,109 |
$201K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,992 |
1,774 |
$189K |
| D1110 |
Prophylaxis - adult |
4,158 |
4,148 |
$181K |
| D1206 |
Topical application of fluoride varnish |
8,156 |
8,145 |
$178K |
| D1120 |
Prophylaxis - child |
4,995 |
4,987 |
$169K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,948 |
4,060 |
$146K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,502 |
985 |
$130K |
| D0274 |
Bitewings - four radiographic images |
3,325 |
3,320 |
$84K |
| D1351 |
Sealant - per tooth |
2,472 |
974 |
$77K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
666 |
532 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
6,273 |
6,207 |
$63K |
| D0330 |
Panoramic radiographic image |
1,523 |
1,522 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,831 |
5,607 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
673 |
495 |
$41K |
| D2332 |
|
433 |
292 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,244 |
1,243 |
$37K |
| D0272 |
Bitewings - two radiographic images |
2,088 |
2,085 |
$36K |
| D2335 |
|
373 |
185 |
$35K |
| D2331 |
|
335 |
250 |
$25K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
288 |
258 |
$24K |
| D2394 |
|
177 |
146 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
682 |
664 |
$15K |
| D2740 |
Crown - porcelain/ceramic |
28 |
25 |
$14K |
| D2330 |
|
210 |
154 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
324 |
324 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
165 |
165 |
$3K |
| D4346 |
|
43 |
43 |
$2K |
| D2991 |
|
50 |
13 |
$2K |
| D1353 |
|
56 |
28 |
$791.10 |
| D7111 |
|
104 |
85 |
$0.00 |