| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20,584 |
7,728 |
$2.63M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,217 |
3,157 |
$1.59M |
| D1120 |
Prophylaxis - child |
37,365 |
35,978 |
$1.23M |
| D9248 |
|
7,622 |
7,261 |
$1.10M |
| D1206 |
Topical application of fluoride varnish |
46,623 |
44,857 |
$963K |
| D0120 |
Periodic oral evaluation - established patient |
38,951 |
37,631 |
$940K |
| D0272 |
Bitewings - two radiographic images |
28,896 |
27,776 |
$614K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,087 |
4,700 |
$572K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,389 |
3,314 |
$550K |
| D1110 |
Prophylaxis - adult |
10,286 |
9,905 |
$528K |
| D1310 |
|
13,543 |
12,721 |
$510K |
| D1351 |
Sealant - per tooth |
18,925 |
5,709 |
$488K |
| D2929 |
|
2,567 |
640 |
$486K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,359 |
12,694 |
$392K |
| D0330 |
Panoramic radiographic image |
6,634 |
6,318 |
$359K |
| D1330 |
|
13,539 |
12,722 |
$322K |
| D0274 |
Bitewings - four radiographic images |
9,450 |
9,065 |
$311K |
| D0603 |
|
32,058 |
30,874 |
$303K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,209 |
983 |
$209K |
| D0220 |
Intraoral - periapical first radiographic image |
10,635 |
10,010 |
$172K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,247 |
3,073 |
$112K |
| D0425 |
|
2,670 |
2,591 |
$108K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,182 |
3,042 |
$99K |
| D0240 |
|
6,958 |
4,260 |
$93K |
| D0140 |
Limited oral evaluation - problem focused |
2,647 |
2,540 |
$91K |
| D0601 |
|
9,200 |
8,904 |
$86K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,496 |
5,387 |
$79K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
504 |
314 |
$78K |
| D0602 |
|
5,120 |
4,940 |
$47K |
| D9310 |
|
688 |
669 |
$37K |
| D2332 |
|
227 |
118 |
$25K |
| D4342 |
|
198 |
94 |
$16K |
| D2390 |
|
49 |
14 |
$10K |
| D3120 |
|
265 |
159 |
$8K |
| D0470 |
|
182 |
166 |
$6K |
| D2330 |
|
19 |
13 |
$1K |