| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,157 |
10,023 |
$1.55M |
| D0120 |
Periodic oral evaluation - established patient |
50,960 |
47,807 |
$1.27M |
| D1120 |
Prophylaxis - child |
44,557 |
41,753 |
$1.16M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26,770 |
24,359 |
$1.14M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14,313 |
9,658 |
$1.10M |
| D1208 |
Topical application of fluoride, excluding varnish |
50,574 |
47,242 |
$802K |
| D1351 |
Sealant - per tooth |
19,128 |
5,391 |
$504K |
| D1110 |
Prophylaxis - adult |
13,356 |
12,587 |
$494K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,445 |
3,991 |
$388K |
| D0220 |
Intraoral - periapical first radiographic image |
24,588 |
22,566 |
$352K |
| D0272 |
Bitewings - two radiographic images |
18,452 |
17,322 |
$324K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,430 |
5,975 |
$263K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,864 |
1,231 |
$254K |
| D0140 |
Limited oral evaluation - problem focused |
5,748 |
5,337 |
$201K |
| D0274 |
Bitewings - four radiographic images |
6,469 |
6,137 |
$200K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,683 |
8,184 |
$167K |
| D0240 |
|
9,847 |
4,805 |
$157K |
| D1206 |
Topical application of fluoride varnish |
6,658 |
6,391 |
$106K |
| D0330 |
Panoramic radiographic image |
1,376 |
1,338 |
$79K |
| D0170 |
|
1,101 |
1,027 |
$31K |
| D9420 |
|
102 |
88 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
57 |
$8K |
| D2934 |
|
29 |
13 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
348 |
229 |
$5K |
| D1354 |
|
742 |
262 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
27 |
12 |
$2K |
| D2940 |
|
19 |
12 |
$567.58 |