| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,252 |
4,736 |
$759K |
| D1120 |
Prophylaxis - child |
14,849 |
14,238 |
$516K |
| D0120 |
Periodic oral evaluation - established patient |
14,992 |
14,326 |
$412K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,722 |
8,247 |
$347K |
| D1110 |
Prophylaxis - adult |
6,755 |
6,468 |
$326K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,198 |
827 |
$322K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,497 |
1,589 |
$295K |
| D0330 |
Panoramic radiographic image |
4,948 |
4,722 |
$282K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,055 |
12,568 |
$257K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,689 |
4,506 |
$208K |
| D0272 |
Bitewings - two radiographic images |
9,677 |
9,292 |
$203K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,980 |
2,040 |
$201K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,888 |
7,196 |
$151K |
| D1206 |
Topical application of fluoride varnish |
6,097 |
5,825 |
$149K |
| D0220 |
Intraoral - periapical first radiographic image |
9,443 |
8,950 |
$130K |
| D1351 |
Sealant - per tooth |
4,022 |
1,191 |
$111K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,938 |
1,860 |
$95K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
747 |
388 |
$70K |
| D7140 |
Extraction, erupted tooth or exposed root |
735 |
337 |
$41K |
| D2931 |
|
116 |
81 |
$25K |
| D7111 |
|
547 |
281 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
1,497 |
1,394 |
$20K |
| D2950 |
|
71 |
55 |
$11K |
| D9920 |
|
127 |
72 |
$6K |
| D9420 |
|
60 |
38 |
$4K |
| D2394 |
|
16 |
12 |
$3K |
| D2330 |
|
37 |
25 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
13 |
$718.98 |