| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,510 |
8,652 |
$2.29M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,408 |
4,371 |
$1.35M |
| D9248 |
|
7,714 |
7,603 |
$1.09M |
| D7140 |
Extraction, erupted tooth or exposed root |
8,443 |
4,535 |
$820K |
| D1120 |
Prophylaxis - child |
23,019 |
22,870 |
$786K |
| D2934 |
|
4,583 |
1,678 |
$778K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,492 |
2,858 |
$718K |
| D1206 |
Topical application of fluoride varnish |
30,981 |
30,788 |
$597K |
| D0120 |
Periodic oral evaluation - established patient |
24,741 |
24,632 |
$590K |
| D3230 |
|
4,500 |
1,611 |
$531K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,840 |
3,286 |
$496K |
| D1351 |
Sealant - per tooth |
12,328 |
4,794 |
$440K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,241 |
17,112 |
$420K |
| D1510 |
|
2,815 |
2,140 |
$415K |
| D1110 |
Prophylaxis - adult |
8,505 |
8,463 |
$394K |
| D3240 |
|
2,660 |
1,166 |
$368K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,488 |
2,290 |
$357K |
| D0220 |
Intraoral - periapical first radiographic image |
23,025 |
22,686 |
$291K |
| D0240 |
|
13,995 |
13,912 |
$274K |
| D0274 |
Bitewings - four radiographic images |
6,603 |
6,566 |
$201K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,502 |
4,493 |
$184K |
| D0272 |
Bitewings - two radiographic images |
8,371 |
8,331 |
$174K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,074 |
5,040 |
$159K |
| D2332 |
|
1,038 |
783 |
$153K |
| D2390 |
|
503 |
316 |
$122K |
| D3120 |
|
3,064 |
1,845 |
$114K |
| D2335 |
|
614 |
359 |
$108K |
| D0140 |
Limited oral evaluation - problem focused |
1,810 |
1,790 |
$64K |
| D9310 |
|
1,189 |
1,189 |
$49K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,494 |
1,491 |
$48K |
| D0350 |
|
592 |
405 |
$39K |
| D9219 |
|
325 |
320 |
$13K |
| D9420 |
|
112 |
111 |
$12K |
| D2920 |
|
146 |
137 |
$7K |
| D7111 |
|
62 |
46 |
$7K |
| D1353 |
|
135 |
38 |
$5K |
| D0330 |
Panoramic radiographic image |
68 |
67 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
127 |
123 |
$2K |