| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,166 |
1,830 |
$257K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,615 |
1,595 |
$250K |
| D1120 |
Prophylaxis - child |
8,868 |
8,645 |
$160K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,517 |
9,265 |
$132K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,144 |
864 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
7,051 |
6,856 |
$112K |
| D1351 |
Sealant - per tooth |
3,609 |
1,106 |
$71K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
729 |
308 |
$70K |
| D2335 |
|
597 |
200 |
$54K |
| D0272 |
Bitewings - two radiographic images |
3,741 |
3,659 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
725 |
342 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,513 |
1,489 |
$31K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
477 |
205 |
$28K |
| D0330 |
Panoramic radiographic image |
565 |
552 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
835 |
796 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,014 |
1,104 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
589 |
585 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
231 |
90 |
$12K |
| D2332 |
|
167 |
97 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
2,350 |
2,254 |
$11K |
| D2160 |
|
69 |
25 |
$4K |
| D1110 |
Prophylaxis - adult |
149 |
136 |
$4K |
| D2140 |
|
27 |
13 |
$1K |
| D0274 |
Bitewings - four radiographic images |
76 |
72 |
$1K |
| D1999 |
|
63 |
56 |
$0.00 |