| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,057 |
8,102 |
$1.53M |
| D0120 |
Periodic oral evaluation - established patient |
37,807 |
37,088 |
$999K |
| D1120 |
Prophylaxis - child |
28,336 |
27,794 |
$787K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,977 |
15,444 |
$717K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,372 |
5,821 |
$685K |
| D1206 |
Topical application of fluoride varnish |
32,723 |
32,001 |
$540K |
| D1110 |
Prophylaxis - adult |
12,206 |
11,980 |
$474K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,099 |
2,122 |
$462K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,224 |
2,448 |
$355K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,940 |
2,826 |
$321K |
| D0330 |
Panoramic radiographic image |
3,704 |
3,653 |
$197K |
| D0272 |
Bitewings - two radiographic images |
9,428 |
9,255 |
$175K |
| D0274 |
Bitewings - four radiographic images |
5,407 |
5,307 |
$173K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,638 |
4,298 |
$164K |
| D1351 |
Sealant - per tooth |
4,503 |
1,354 |
$128K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,591 |
7,529 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,319 |
2,267 |
$106K |
| D0220 |
Intraoral - periapical first radiographic image |
6,899 |
6,709 |
$105K |
| D0140 |
Limited oral evaluation - problem focused |
897 |
878 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
161 |
125 |
$21K |
| D2934 |
|
62 |
26 |
$12K |
| D2330 |
|
63 |
49 |
$4K |
| D9215 |
|
82 |
79 |
$0.00 |
| D9920 |
|
76 |
73 |
$0.00 |