| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,792 |
2,961 |
$566K |
| D1120 |
Prophylaxis - child |
11,389 |
11,386 |
$460K |
| D1206 |
Topical application of fluoride varnish |
14,377 |
14,374 |
$385K |
| D0120 |
Periodic oral evaluation - established patient |
9,971 |
9,970 |
$312K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,714 |
1,879 |
$240K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,983 |
6,933 |
$214K |
| D9310 |
|
2,310 |
2,310 |
$180K |
| D0210 |
Intraoral - complete series of radiographic images |
3,038 |
2,960 |
$179K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,843 |
2,843 |
$159K |
| D0220 |
Intraoral - periapical first radiographic image |
8,878 |
8,692 |
$152K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
798 |
644 |
$151K |
| D0240 |
|
7,576 |
4,119 |
$150K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,244 |
919 |
$105K |
| D1351 |
Sealant - per tooth |
3,617 |
1,435 |
$105K |
| D1110 |
Prophylaxis - adult |
2,087 |
2,087 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
1,394 |
1,389 |
$76K |
| D0274 |
Bitewings - four radiographic images |
1,939 |
1,939 |
$62K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
393 |
289 |
$57K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,190 |
1,190 |
$49K |
| D0272 |
Bitewings - two radiographic images |
1,949 |
1,949 |
$48K |
| D2710 |
|
68 |
56 |
$40K |
| D2940 |
|
484 |
303 |
$33K |
| D2950 |
|
64 |
50 |
$10K |
| D2332 |
|
68 |
44 |
$9K |
| D0330 |
Panoramic radiographic image |
91 |
91 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
27 |
26 |
$3K |
| D2331 |
|
19 |
12 |
$2K |