| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,050 |
1,355 |
$192K |
| D1120 |
Prophylaxis - child |
4,946 |
4,910 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
4,283 |
4,273 |
$101K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,776 |
772 |
$91K |
| D7140 |
Extraction, erupted tooth or exposed root |
911 |
534 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,337 |
3,322 |
$44K |
| D1351 |
Sealant - per tooth |
1,998 |
667 |
$42K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,375 |
1,357 |
$37K |
| D0272 |
Bitewings - two radiographic images |
3,537 |
3,514 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,505 |
1,487 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
742 |
717 |
$26K |
| D0330 |
Panoramic radiographic image |
659 |
652 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
284 |
213 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
719 |
559 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
111 |
65 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
557 |
527 |
$11K |
| D0240 |
|
635 |
315 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
75 |
40 |
$5K |
| D0274 |
Bitewings - four radiographic images |
177 |
176 |
$3K |
| D2331 |
|
27 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
198 |
195 |
$2K |
| D2330 |
|
26 |
14 |
$1K |
| D1110 |
Prophylaxis - adult |
42 |
42 |
$1K |