| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18,175 |
12,821 |
$1.82M |
| D0120 |
Periodic oral evaluation - established patient |
43,235 |
40,205 |
$1.06M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20,954 |
18,286 |
$868K |
| D1120 |
Prophylaxis - child |
30,142 |
28,059 |
$778K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,223 |
7,778 |
$761K |
| D1208 |
Topical application of fluoride, excluding varnish |
43,126 |
40,118 |
$675K |
| D1110 |
Prophylaxis - adult |
16,287 |
15,101 |
$585K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,599 |
4,748 |
$459K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,934 |
1,942 |
$404K |
| D0274 |
Bitewings - four radiographic images |
9,168 |
8,489 |
$274K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,034 |
1,691 |
$258K |
| D1351 |
Sealant - per tooth |
9,775 |
2,843 |
$249K |
| D0272 |
Bitewings - two radiographic images |
12,914 |
11,995 |
$221K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,106 |
2,878 |
$129K |
| D0140 |
Limited oral evaluation - problem focused |
2,936 |
2,723 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
6,495 |
5,902 |
$90K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
981 |
666 |
$69K |
| D0240 |
|
2,686 |
1,452 |
$38K |
| D0330 |
Panoramic radiographic image |
764 |
618 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,980 |
1,841 |
$30K |
| D2330 |
|
82 |
62 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
492 |
239 |
$5K |