| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23,348 |
5,186 |
$1.25M |
| D0120 |
Periodic oral evaluation - established patient |
30,890 |
29,968 |
$798K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,922 |
1,107 |
$788K |
| D1120 |
Prophylaxis - child |
28,711 |
27,833 |
$665K |
| D1206 |
Topical application of fluoride varnish |
23,914 |
22,913 |
$473K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,107 |
3,301 |
$447K |
| D9999 |
Unspecified adjunctive procedure, by report |
7,623 |
7,379 |
$213K |
| D1110 |
Prophylaxis - adult |
5,614 |
5,437 |
$212K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,597 |
1,627 |
$194K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,241 |
835 |
$183K |
| D0330 |
Panoramic radiographic image |
4,312 |
4,186 |
$165K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,829 |
9,779 |
$162K |
| D0274 |
Bitewings - four radiographic images |
10,497 |
10,105 |
$149K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,710 |
3,567 |
$145K |
| D2330 |
|
2,162 |
263 |
$126K |
| D9630 |
|
2,491 |
2,165 |
$97K |
| D0140 |
Limited oral evaluation - problem focused |
2,763 |
2,636 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
746 |
593 |
$50K |
| D0272 |
Bitewings - two radiographic images |
3,705 |
3,683 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
4,484 |
4,289 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
670 |
593 |
$15K |
| D9920 |
|
678 |
664 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,363 |
3,409 |
$10K |
| D2331 |
|
141 |
58 |
$9K |
| D1351 |
Sealant - per tooth |
234 |
109 |
$5K |
| D1330 |
|
800 |
645 |
$0.00 |