| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
19,611 |
5,126 |
$576K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,492 |
3,281 |
$405K |
| D1120 |
Prophylaxis - child |
11,149 |
10,229 |
$284K |
| D0330 |
Panoramic radiographic image |
6,453 |
5,754 |
$267K |
| D1999 |
|
12,941 |
12,084 |
$246K |
| D0120 |
Periodic oral evaluation - established patient |
12,290 |
11,393 |
$214K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,421 |
14,077 |
$204K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,133 |
1,919 |
$191K |
| D1110 |
Prophylaxis - adult |
5,529 |
5,029 |
$182K |
| D1351 |
Sealant - per tooth |
8,852 |
2,362 |
$182K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,367 |
6,587 |
$167K |
| D0272 |
Bitewings - two radiographic images |
10,997 |
10,077 |
$150K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,370 |
927 |
$122K |
| D0274 |
Bitewings - four radiographic images |
5,585 |
5,070 |
$101K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,794 |
1,148 |
$94K |
| D1206 |
Topical application of fluoride varnish |
3,379 |
3,163 |
$68K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,889 |
1,603 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,106 |
1,015 |
$28K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
207 |
150 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,070 |
1,758 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
128 |
86 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
170 |
85 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
23 |
12 |
$8K |
| D3120 |
|
214 |
141 |
$4K |
| D2335 |
|
30 |
12 |
$3K |
| D2950 |
|
35 |
24 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
69 |
53 |
$556.50 |
| D9999 |
Unspecified adjunctive procedure, by report |
375 |
249 |
$0.00 |