| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,512 |
6,488 |
$961K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,133 |
3,035 |
$517K |
| D1110 |
Prophylaxis - adult |
9,403 |
9,403 |
$472K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,000 |
3,623 |
$414K |
| D0120 |
Periodic oral evaluation - established patient |
17,686 |
17,686 |
$411K |
| D1120 |
Prophylaxis - child |
10,110 |
10,110 |
$354K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,186 |
20,186 |
$331K |
| D0272 |
Bitewings - two radiographic images |
16,705 |
16,705 |
$315K |
| D0330 |
Panoramic radiographic image |
3,627 |
3,627 |
$168K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,317 |
1,317 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
3,841 |
3,820 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,134 |
1,134 |
$32K |
| D1351 |
Sealant - per tooth |
744 |
264 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,936 |
1,859 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
434 |
429 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
230 |
230 |
$13K |
| D2394 |
|
72 |
49 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
50 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
88 |
77 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
201 |
192 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
46 |
39 |
$6K |
| D7111 |
|
67 |
55 |
$4K |
| D2330 |
|
37 |
26 |
$3K |
| D2332 |
|
23 |
15 |
$2K |
| D0240 |
|
84 |
48 |
$1K |