| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18,266 |
10,759 |
$2.26M |
| D1120 |
Prophylaxis - child |
32,028 |
31,536 |
$1.40M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,381 |
3,328 |
$1.17M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,706 |
7,720 |
$1.12M |
| D0120 |
Periodic oral evaluation - established patient |
36,340 |
35,801 |
$1.08M |
| D1351 |
Sealant - per tooth |
29,843 |
8,648 |
$1.01M |
| D7140 |
Extraction, erupted tooth or exposed root |
7,243 |
4,006 |
$791K |
| D1208 |
Topical application of fluoride, excluding varnish |
28,935 |
28,464 |
$652K |
| D1110 |
Prophylaxis - adult |
8,851 |
8,732 |
$533K |
| D9248 |
|
2,815 |
2,676 |
$519K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,970 |
2,313 |
$463K |
| D1206 |
Topical application of fluoride varnish |
16,293 |
16,091 |
$415K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19,656 |
16,873 |
$361K |
| D0272 |
Bitewings - two radiographic images |
22,794 |
22,454 |
$348K |
| D2335 |
|
2,056 |
941 |
$318K |
| D0274 |
Bitewings - four radiographic images |
12,207 |
12,035 |
$274K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,903 |
4,826 |
$258K |
| D3120 |
|
6,903 |
3,987 |
$238K |
| D0140 |
Limited oral evaluation - problem focused |
4,994 |
4,845 |
$221K |
| D2331 |
|
1,874 |
1,232 |
$200K |
| D0330 |
Panoramic radiographic image |
3,599 |
3,556 |
$155K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,678 |
3,620 |
$151K |
| D2332 |
|
1,111 |
749 |
$145K |
| D1330 |
|
23,192 |
22,836 |
$143K |
| D2330 |
|
1,352 |
820 |
$117K |
| D0220 |
Intraoral - periapical first radiographic image |
8,837 |
8,422 |
$86K |
| D9310 |
|
1,733 |
1,710 |
$82K |
| D0240 |
|
4,973 |
4,869 |
$73K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,086 |
624 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,860 |
3,740 |
$46K |
| D9420 |
|
1,776 |
1,737 |
$26K |
| D1510 |
|
49 |
43 |
$4K |
| D0270 |
|
353 |
349 |
$3K |