| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,723 |
4,397 |
$499K |
| D0330 |
Panoramic radiographic image |
8,313 |
8,180 |
$430K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,463 |
2,636 |
$359K |
| D0274 |
Bitewings - four radiographic images |
12,010 |
11,853 |
$353K |
| D1110 |
Prophylaxis - adult |
8,006 |
7,931 |
$348K |
| D0120 |
Periodic oral evaluation - established patient |
10,672 |
10,482 |
$277K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,641 |
8,453 |
$270K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,070 |
2,665 |
$226K |
| D1206 |
Topical application of fluoride varnish |
9,390 |
9,264 |
$208K |
| D1351 |
Sealant - per tooth |
8,076 |
1,786 |
$199K |
| D0140 |
Limited oral evaluation - problem focused |
7,039 |
6,674 |
$199K |
| D0220 |
Intraoral - periapical first radiographic image |
15,822 |
14,712 |
$197K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,716 |
9,853 |
$195K |
| D1120 |
Prophylaxis - child |
6,246 |
6,160 |
$177K |
| D7111 |
|
1,940 |
1,140 |
$155K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,984 |
1,418 |
$139K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,302 |
787 |
$107K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,018 |
664 |
$104K |
| D0272 |
Bitewings - two radiographic images |
3,952 |
3,894 |
$83K |
| D4341 |
|
199 |
67 |
$38K |
| D2722 |
|
35 |
29 |
$34K |
| D2160 |
|
263 |
210 |
$29K |
| D7250 |
|
360 |
161 |
$23K |
| D0270 |
|
2,707 |
2,660 |
$23K |
| D2940 |
|
493 |
372 |
$20K |
| D2331 |
|
419 |
318 |
$20K |
| D1330 |
|
799 |
795 |
$16K |
| D3310 |
|
37 |
28 |
$9K |
| D5110 |
|
13 |
13 |
$9K |
| D2330 |
|
164 |
116 |
$9K |
| D2140 |
|
124 |
81 |
$9K |
| D2335 |
|
147 |
111 |
$8K |
| D2950 |
|
42 |
35 |
$8K |
| D2332 |
|
189 |
142 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
55 |
40 |
$4K |
| D3320 |
|
26 |
24 |
$4K |
| D2161 |
|
20 |
17 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
136 |
124 |
$3K |
| D0240 |
|
75 |
38 |
$3K |
| D2394 |
|
77 |
67 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
399 |
398 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
156 |
139 |
$840.84 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
29 |
24 |
$721.10 |
| D5225 |
|
24 |
24 |
$0.00 |
| D1999 |
|
80 |
74 |
$0.00 |
| D3120 |
|
21 |
13 |
$0.00 |
| D4355 |
|
12 |
12 |
$0.00 |
| D5226 |
|
27 |
27 |
$0.00 |
| D9920 |
|
14 |
13 |
$0.00 |