| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,688 |
5,254 |
$921K |
| D1120 |
Prophylaxis - child |
24,369 |
23,471 |
$657K |
| D0120 |
Periodic oral evaluation - established patient |
24,101 |
23,336 |
$624K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,479 |
973 |
$479K |
| D1206 |
Topical application of fluoride varnish |
28,592 |
27,526 |
$456K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,581 |
3,477 |
$441K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,249 |
8,261 |
$405K |
| D1351 |
Sealant - per tooth |
10,616 |
3,185 |
$286K |
| D0240 |
|
15,701 |
7,872 |
$250K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,815 |
4,538 |
$204K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,258 |
1,791 |
$203K |
| D0160 |
|
2,886 |
2,735 |
$193K |
| D1110 |
Prophylaxis - adult |
4,769 |
4,607 |
$182K |
| D0272 |
Bitewings - two radiographic images |
10,148 |
9,737 |
$177K |
| D0220 |
Intraoral - periapical first radiographic image |
11,067 |
10,478 |
$165K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,083 |
777 |
$139K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,217 |
7,559 |
$120K |
| D0140 |
Limited oral evaluation - problem focused |
3,263 |
3,058 |
$119K |
| D0330 |
Panoramic radiographic image |
1,869 |
1,809 |
$109K |
| D0274 |
Bitewings - four radiographic images |
2,050 |
1,972 |
$64K |
| D9420 |
|
304 |
267 |
$31K |
| D1510 |
|
122 |
101 |
$23K |
| D2330 |
|
298 |
166 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
128 |
69 |
$10K |
| D0170 |
|
289 |
274 |
$8K |
| D1354 |
|
661 |
232 |
$4K |
| D7111 |
|
33 |
24 |
$2K |
| D2331 |
|
21 |
15 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
98 |
96 |
$1K |
| D0270 |
|
30 |
29 |
$132.05 |
| D1999 |
|
135 |
113 |
$0.00 |