| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,418 |
8,489 |
$1.57M |
| D0120 |
Periodic oral evaluation - established patient |
37,947 |
37,433 |
$1.01M |
| D1120 |
Prophylaxis - child |
29,067 |
28,638 |
$811K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16,842 |
16,286 |
$761K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,361 |
5,916 |
$683K |
| D1206 |
Topical application of fluoride varnish |
34,701 |
34,091 |
$574K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,317 |
2,242 |
$491K |
| D1110 |
Prophylaxis - adult |
12,320 |
12,124 |
$479K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,545 |
2,615 |
$379K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,890 |
2,991 |
$320K |
| D0330 |
Panoramic radiographic image |
3,961 |
3,883 |
$208K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,270 |
6,379 |
$205K |
| D0274 |
Bitewings - four radiographic images |
5,624 |
5,519 |
$181K |
| D0272 |
Bitewings - two radiographic images |
9,393 |
9,250 |
$174K |
| D1351 |
Sealant - per tooth |
5,646 |
1,799 |
$161K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,407 |
3,291 |
$153K |
| D0220 |
Intraoral - periapical first radiographic image |
9,821 |
9,649 |
$151K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,253 |
6,238 |
$103K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
434 |
335 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,527 |
1,501 |
$58K |
| D2934 |
|
243 |
104 |
$47K |
| D2330 |
|
120 |
93 |
$8K |
| D0170 |
|
12 |
12 |
$378.60 |
| D9215 |
|
31 |
31 |
$0.00 |