| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,732 |
4,282 |
$1.03M |
| D0120 |
Periodic oral evaluation - established patient |
26,018 |
25,384 |
$678K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,415 |
1,438 |
$629K |
| D1120 |
Prophylaxis - child |
22,302 |
21,720 |
$608K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,638 |
16,249 |
$276K |
| D1351 |
Sealant - per tooth |
9,355 |
2,962 |
$260K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,226 |
1,912 |
$256K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,940 |
1,309 |
$251K |
| D1110 |
Prophylaxis - adult |
6,318 |
6,183 |
$243K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,403 |
5,170 |
$238K |
| D0272 |
Bitewings - two radiographic images |
10,141 |
9,840 |
$186K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,860 |
1,584 |
$180K |
| D1206 |
Topical application of fluoride varnish |
10,867 |
10,582 |
$176K |
| D0330 |
Panoramic radiographic image |
2,641 |
2,557 |
$149K |
| D9420 |
|
1,008 |
937 |
$115K |
| D0220 |
Intraoral - periapical first radiographic image |
7,237 |
6,987 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,400 |
2,321 |
$105K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,137 |
576 |
$91K |
| D0274 |
Bitewings - four radiographic images |
2,510 |
2,460 |
$81K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,019 |
4,893 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
1,088 |
1,057 |
$41K |
| D2934 |
|
193 |
51 |
$38K |
| D1354 |
|
2,283 |
800 |
$15K |
| D2330 |
|
39 |
25 |
$3K |
| D2331 |
|
31 |
12 |
$2K |
| D9440 |
|
12 |
12 |
$770.52 |