| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13,769 |
2,805 |
$1.44M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,861 |
923 |
$254K |
| D1110 |
Prophylaxis - adult |
2,641 |
2,634 |
$114K |
| D2330 |
|
1,070 |
463 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
3,911 |
3,906 |
$89K |
| D1120 |
Prophylaxis - child |
2,457 |
2,452 |
$77K |
| D1206 |
Topical application of fluoride varnish |
4,167 |
4,157 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,255 |
2,181 |
$70K |
| D7140 |
Extraction, erupted tooth or exposed root |
664 |
243 |
$64K |
| D0330 |
Panoramic radiographic image |
1,050 |
1,048 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,592 |
1,588 |
$46K |
| D3120 |
|
1,088 |
502 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
212 |
123 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
808 |
802 |
$31K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
168 |
72 |
$21K |
| D0272 |
Bitewings - two radiographic images |
764 |
763 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
180 |
84 |
$15K |
| D1351 |
Sealant - per tooth |
420 |
153 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
227 |
223 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
717 |
712 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
368 |
363 |
$4K |