| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,409 |
3,948 |
$255K |
| D1120 |
Prophylaxis - child |
16,108 |
16,047 |
$251K |
| D0120 |
Periodic oral evaluation - established patient |
17,011 |
16,950 |
$193K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,270 |
1,199 |
$188K |
| D1351 |
Sealant - per tooth |
11,340 |
3,476 |
$184K |
| D1206 |
Topical application of fluoride varnish |
14,319 |
14,259 |
$159K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,597 |
1,066 |
$136K |
| D2335 |
|
1,087 |
385 |
$107K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,443 |
1,697 |
$104K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,285 |
940 |
$94K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,640 |
5,322 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,342 |
3,342 |
$63K |
| D0330 |
Panoramic radiographic image |
2,317 |
2,304 |
$62K |
| D0240 |
|
5,817 |
3,846 |
$60K |
| D1110 |
Prophylaxis - adult |
1,831 |
1,827 |
$58K |
| D0272 |
Bitewings - two radiographic images |
5,757 |
5,734 |
$55K |
| D9248 |
|
345 |
345 |
$33K |
| D9920 |
|
13,043 |
12,707 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,585 |
1,584 |
$28K |
| D0603 |
|
8,998 |
8,961 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,503 |
1,212 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
3,193 |
3,171 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,444 |
2,438 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
1,951 |
1,901 |
$12K |
| D9110 |
|
359 |
356 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
848 |
841 |
$6K |
| D1510 |
|
27 |
24 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,159 |
1,150 |
$4K |
| D0602 |
|
205 |
202 |
$660.00 |
| D8660 |
|
13 |
13 |
$495.00 |
| D0601 |
|
155 |
154 |
$430.00 |
| D0160 |
|
42 |
41 |
$140.00 |
| D1354 |
|
17 |
13 |
$10.00 |
| D1999 |
|
1,282 |
1,171 |
$0.00 |
| D1330 |
|
4,435 |
4,389 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$0.00 |