| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4212 |
|
4,649 |
1,008 |
$1.52M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
9,112 |
4,316 |
$732K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,517 |
1,751 |
$590K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,894 |
2,095 |
$455K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,557 |
2,406 |
$408K |
| D0120 |
Periodic oral evaluation - established patient |
16,440 |
15,544 |
$335K |
| D0272 |
Bitewings - two radiographic images |
15,286 |
14,424 |
$330K |
| D1110 |
Prophylaxis - adult |
7,673 |
7,222 |
$330K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,658 |
12,908 |
$262K |
| D1120 |
Prophylaxis - child |
8,087 |
7,652 |
$244K |
| D1351 |
Sealant - per tooth |
10,056 |
2,803 |
$239K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,545 |
1,978 |
$229K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,990 |
6,841 |
$206K |
| D0210 |
Intraoral - complete series of radiographic images |
3,312 |
3,187 |
$111K |
| D0330 |
Panoramic radiographic image |
2,357 |
2,204 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,459 |
2,317 |
$81K |
| D2330 |
|
786 |
303 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,387 |
1,302 |
$44K |
| D2931 |
|
275 |
139 |
$41K |
| D9920 |
|
372 |
314 |
$21K |
| D2332 |
|
157 |
78 |
$17K |
| D4910 |
|
118 |
103 |
$13K |
| D2390 |
|
106 |
37 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
284 |
189 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
749 |
684 |
$8K |
| D0160 |
|
62 |
56 |
$5K |
| D3120 |
|
165 |
121 |
$0.00 |