| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,886 |
7,388 |
$733K |
| D1110 |
Prophylaxis - adult |
12,306 |
12,306 |
$555K |
| D0120 |
Periodic oral evaluation - established patient |
24,003 |
24,003 |
$544K |
| D0274 |
Bitewings - four radiographic images |
19,746 |
19,746 |
$449K |
| D1120 |
Prophylaxis - child |
11,758 |
11,757 |
$398K |
| D0220 |
Intraoral - periapical first radiographic image |
25,821 |
25,756 |
$283K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,117 |
3,375 |
$203K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,122 |
1,933 |
$196K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,964 |
22,952 |
$168K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,109 |
13,109 |
$149K |
| D1206 |
Topical application of fluoride varnish |
4,039 |
4,039 |
$96K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,455 |
1,313 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
3,740 |
3,634 |
$39K |
| D2750 |
|
71 |
70 |
$37K |
| D9310 |
|
539 |
539 |
$33K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
312 |
289 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
3,331 |
3,312 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
136 |
104 |
$12K |
| D2954 |
|
87 |
86 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
99 |
94 |
$8K |
| D1354 |
|
365 |
162 |
$8K |
| D2331 |
|
81 |
71 |
$7K |
| D0272 |
Bitewings - two radiographic images |
391 |
391 |
$5K |
| D1351 |
Sealant - per tooth |
132 |
56 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
190 |
190 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
168 |
168 |
$4K |
| D9110 |
|
137 |
137 |
$3K |
| D2332 |
|
16 |
15 |
$2K |
| D0270 |
|
126 |
126 |
$1K |
| D9440 |
|
53 |
52 |
$1K |
| D2140 |
|
13 |
13 |
$699.38 |