| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
50,392 |
25,139 |
$5.28M |
| D1120 |
Prophylaxis - child |
113,571 |
110,120 |
$3.10M |
| D0120 |
Periodic oral evaluation - established patient |
110,554 |
107,651 |
$2.88M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21,245 |
7,652 |
$2.76M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
42,797 |
39,667 |
$1.89M |
| D1351 |
Sealant - per tooth |
66,827 |
19,138 |
$1.85M |
| D1206 |
Topical application of fluoride varnish |
112,384 |
108,589 |
$1.83M |
| D7140 |
Extraction, erupted tooth or exposed root |
27,534 |
13,084 |
$1.69M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13,886 |
9,460 |
$1.10M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
8,799 |
4,740 |
$1.06M |
| D0272 |
Bitewings - two radiographic images |
51,899 |
50,194 |
$947K |
| D1110 |
Prophylaxis - adult |
23,278 |
22,688 |
$896K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19,426 |
18,657 |
$859K |
| D0330 |
Panoramic radiographic image |
14,348 |
13,960 |
$794K |
| D9420 |
|
6,600 |
5,573 |
$692K |
| D2934 |
|
3,460 |
907 |
$516K |
| D0140 |
Limited oral evaluation - problem focused |
14,252 |
13,224 |
$509K |
| D0220 |
Intraoral - periapical first radiographic image |
31,826 |
30,577 |
$477K |
| D0240 |
|
28,288 |
15,777 |
$447K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,650 |
2,392 |
$393K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,507 |
14,701 |
$381K |
| D7240 |
Removal of impacted tooth - completely bony |
2,650 |
497 |
$364K |
| D0274 |
Bitewings - four radiographic images |
11,379 |
11,076 |
$362K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,898 |
21,635 |
$349K |
| D2335 |
|
1,714 |
635 |
$166K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,521 |
4,120 |
$148K |
| D2332 |
|
923 |
498 |
$91K |
| D1510 |
|
445 |
314 |
$75K |
| D9222 |
|
750 |
527 |
$39K |
| D1354 |
|
6,005 |
2,146 |
$39K |
| D9612 |
|
549 |
369 |
$22K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
196 |
152 |
$11K |
| D9610 |
|
210 |
161 |
$6K |
| D2929 |
|
52 |
12 |
$6K |
| D2933 |
|
52 |
12 |
$5K |
| D2330 |
|
81 |
38 |
$5K |
| D7111 |
|
18 |
14 |
$970.38 |
| D9310 |
|
136 |
90 |
$0.00 |
| D4212 |
|
20 |
12 |
$0.00 |