| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,857 |
3,770 |
$837K |
| D1120 |
Prophylaxis - child |
16,612 |
16,610 |
$676K |
| D0120 |
Periodic oral evaluation - established patient |
16,523 |
16,517 |
$534K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,798 |
1,880 |
$529K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,356 |
2,565 |
$374K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,433 |
2,349 |
$316K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,365 |
1,681 |
$295K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,476 |
10,474 |
$278K |
| D1351 |
Sealant - per tooth |
8,248 |
2,431 |
$261K |
| D1206 |
Topical application of fluoride varnish |
7,012 |
7,010 |
$197K |
| D0272 |
Bitewings - two radiographic images |
7,451 |
7,449 |
$180K |
| D0140 |
Limited oral evaluation - problem focused |
2,341 |
2,335 |
$142K |
| D1110 |
Prophylaxis - adult |
1,713 |
1,712 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,328 |
1,328 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
4,214 |
4,168 |
$75K |
| D9248 |
|
1,299 |
1,251 |
$74K |
| D0240 |
|
3,350 |
1,940 |
$68K |
| D1510 |
|
336 |
304 |
$67K |
| D2335 |
|
262 |
151 |
$46K |
| D0330 |
Panoramic radiographic image |
595 |
595 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,861 |
1,624 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,010 |
1,009 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
229 |
196 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
284 |
284 |
$23K |
| D2332 |
|
113 |
83 |
$15K |
| D2330 |
|
131 |
97 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
131 |
131 |
$5K |
| D3120 |
|
48 |
41 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,189 |
3,092 |
$0.00 |