| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,226 |
9,961 |
$1.36M |
| D1120 |
Prophylaxis - child |
41,144 |
40,196 |
$1.16M |
| D0120 |
Periodic oral evaluation - established patient |
52,548 |
51,469 |
$1.01M |
| D1208 |
Topical application of fluoride, excluding varnish |
58,501 |
57,170 |
$868K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,326 |
8,313 |
$779K |
| D1999 |
|
32,862 |
31,078 |
$623K |
| D1110 |
Prophylaxis - adult |
13,909 |
13,682 |
$524K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
22,062 |
20,901 |
$485K |
| D0330 |
Panoramic radiographic image |
9,377 |
9,158 |
$454K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,263 |
2,185 |
$401K |
| D0272 |
Bitewings - two radiographic images |
19,466 |
18,998 |
$351K |
| D1351 |
Sealant - per tooth |
12,243 |
3,951 |
$299K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,394 |
2,594 |
$231K |
| D0274 |
Bitewings - four radiographic images |
6,134 |
6,020 |
$148K |
| D7240 |
Removal of impacted tooth - completely bony |
625 |
167 |
$123K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,495 |
3,357 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
3,145 |
2,964 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
1,259 |
1,086 |
$32K |
| D9222 |
|
194 |
178 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
250 |
214 |
$23K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
204 |
179 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
207 |
128 |
$15K |
| D1354 |
|
1,175 |
415 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
455 |
431 |
$10K |
| D2330 |
|
164 |
105 |
$9K |
| D2331 |
|
111 |
83 |
$7K |
| D7230 |
|
20 |
13 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
383 |
190 |
$3K |
| D9612 |
|
155 |
140 |
$1K |
| D9610 |
|
19 |
19 |
$162.00 |