| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15,233 |
6,130 |
$950K |
| D9920 |
|
13,832 |
13,144 |
$832K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,357 |
5,772 |
$686K |
| D1120 |
Prophylaxis - child |
16,592 |
16,461 |
$480K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,669 |
23,471 |
$421K |
| D0120 |
Periodic oral evaluation - established patient |
21,686 |
21,493 |
$370K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,248 |
10,442 |
$310K |
| D1110 |
Prophylaxis - adult |
7,591 |
7,487 |
$294K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,949 |
2,269 |
$289K |
| D9630 |
|
17,354 |
17,185 |
$284K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,453 |
2,253 |
$274K |
| D0274 |
Bitewings - four radiographic images |
9,129 |
9,010 |
$211K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,333 |
827 |
$182K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,254 |
812 |
$105K |
| D1351 |
Sealant - per tooth |
3,871 |
1,771 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
3,633 |
3,438 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,813 |
2,669 |
$74K |
| D0210 |
Intraoral - complete series of radiographic images |
2,358 |
2,066 |
$69K |
| D3120 |
|
4,214 |
2,782 |
$57K |
| D2394 |
|
403 |
334 |
$50K |
| D0330 |
Panoramic radiographic image |
1,002 |
923 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,436 |
3,253 |
$32K |
| D2332 |
|
626 |
376 |
$28K |
| D0240 |
|
2,481 |
1,261 |
$27K |
| D1515 |
|
120 |
75 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,854 |
915 |
$19K |
| D9944 |
|
87 |
84 |
$18K |
| D2330 |
|
332 |
197 |
$17K |
| D0272 |
Bitewings - two radiographic images |
751 |
745 |
$13K |
| D1516 |
|
16 |
16 |
$4K |
| D1517 |
|
13 |
13 |
$3K |
| D2335 |
|
95 |
55 |
$3K |
| D2331 |
|
16 |
12 |
$2K |
| D2950 |
|
12 |
12 |
$1K |
| D1999 |
|
14 |
13 |
$0.00 |