| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,174 |
2,373 |
$548K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,341 |
1,687 |
$343K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,022 |
1,018 |
$337K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,206 |
2,232 |
$290K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,589 |
1,143 |
$271K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,801 |
883 |
$188K |
| D1120 |
Prophylaxis - child |
4,402 |
3,436 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
5,293 |
4,130 |
$112K |
| D0140 |
Limited oral evaluation - problem focused |
2,990 |
2,335 |
$92K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,367 |
1,715 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,417 |
3,706 |
$85K |
| D1110 |
Prophylaxis - adult |
1,781 |
1,374 |
$79K |
| D2330 |
|
1,305 |
619 |
$78K |
| D0272 |
Bitewings - two radiographic images |
3,055 |
2,402 |
$64K |
| D9630 |
|
2,754 |
2,169 |
$64K |
| D2331 |
|
867 |
371 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
3,179 |
2,467 |
$52K |
| D0330 |
Panoramic radiographic image |
940 |
763 |
$49K |
| D0240 |
|
1,836 |
1,450 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,394 |
822 |
$20K |
| D0274 |
Bitewings - four radiographic images |
625 |
482 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
496 |
429 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,135 |
409 |
$13K |
| D1351 |
Sealant - per tooth |
247 |
41 |
$8K |
| D1510 |
|
53 |
26 |
$7K |
| D2394 |
|
114 |
53 |
$5K |
| D0470 |
|
143 |
87 |
$3K |
| D2332 |
|
18 |
12 |
$2K |
| D9986 |
|
221 |
208 |
$0.00 |
| D1999 |
|
63 |
38 |
$0.00 |