| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,702 |
2,515 |
$793K |
| D1120 |
Prophylaxis - child |
9,944 |
9,749 |
$372K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,609 |
1,206 |
$251K |
| D0120 |
Periodic oral evaluation - established patient |
8,401 |
8,241 |
$242K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,626 |
343 |
$218K |
| D1206 |
Topical application of fluoride varnish |
11,612 |
11,385 |
$204K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,481 |
1,047 |
$195K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,396 |
3,340 |
$186K |
| D9248 |
|
1,369 |
1,306 |
$183K |
| D1351 |
Sealant - per tooth |
8,052 |
1,786 |
$173K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,126 |
316 |
$153K |
| D0272 |
Bitewings - two radiographic images |
4,251 |
4,152 |
$95K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,152 |
3,042 |
$85K |
| D0140 |
Limited oral evaluation - problem focused |
2,185 |
2,114 |
$73K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
519 |
269 |
$71K |
| D7962 |
|
470 |
454 |
$65K |
| D0330 |
Panoramic radiographic image |
1,094 |
1,074 |
$62K |
| D7961 |
|
430 |
416 |
$58K |
| D9222 |
|
320 |
316 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,733 |
1,383 |
$40K |
| D1110 |
Prophylaxis - adult |
618 |
603 |
$37K |
| D7960 |
|
379 |
209 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,329 |
2,231 |
$32K |
| D2330 |
|
423 |
123 |
$28K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
122 |
57 |
$16K |
| D0240 |
|
110 |
102 |
$2K |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$1K |
| D9420 |
|
42 |
39 |
$0.00 |