| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
5,068 |
5,024 |
$299K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,906 |
1,593 |
$268K |
| D0120 |
Periodic oral evaluation - established patient |
7,463 |
7,407 |
$212K |
| D1120 |
Prophylaxis - child |
5,481 |
5,439 |
$197K |
| D1110 |
Prophylaxis - adult |
3,883 |
3,839 |
$191K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,662 |
6,612 |
$136K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,449 |
3,149 |
$123K |
| D0272 |
Bitewings - two radiographic images |
5,666 |
5,584 |
$119K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
883 |
576 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,498 |
1,448 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
1,810 |
1,584 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
135 |
68 |
$16K |
| D2931 |
|
86 |
63 |
$12K |
| D1206 |
Topical application of fluoride varnish |
303 |
298 |
$8K |
| D7230 |
|
35 |
13 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
77 |
57 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
304 |
302 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
26 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
31 |
15 |
$3K |
| D9243 |
|
37 |
13 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
272 |
107 |
$2K |
| D9239 |
|
13 |
13 |
$1K |
| D2950 |
|
13 |
12 |
$1K |