| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,854 |
1,640 |
$339K |
| D1120 |
Prophylaxis - child |
7,510 |
7,504 |
$309K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,581 |
1,903 |
$309K |
| D0120 |
Periodic oral evaluation - established patient |
8,079 |
8,073 |
$269K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,457 |
1,242 |
$226K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,409 |
1,526 |
$206K |
| D2160 |
|
1,860 |
1,270 |
$190K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
809 |
527 |
$151K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,403 |
4,397 |
$119K |
| D1206 |
Topical application of fluoride varnish |
3,867 |
3,866 |
$109K |
| D1351 |
Sealant - per tooth |
3,071 |
893 |
$98K |
| D0272 |
Bitewings - two radiographic images |
3,223 |
3,221 |
$81K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
646 |
426 |
$79K |
| D1110 |
Prophylaxis - adult |
1,370 |
1,368 |
$70K |
| D0330 |
Panoramic radiographic image |
745 |
742 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
2,533 |
2,493 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
657 |
656 |
$39K |
| D0240 |
|
1,896 |
1,005 |
$38K |
| D0274 |
Bitewings - four radiographic images |
804 |
804 |
$31K |
| D1510 |
|
154 |
140 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,025 |
1,318 |
$27K |
| D9248 |
|
466 |
454 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
361 |
357 |
$21K |
| D2140 |
|
162 |
115 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
141 |
134 |
$0.00 |