| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19,077 |
8,020 |
$1.73M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
11,518 |
5,262 |
$1.60M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,873 |
4,397 |
$1.50M |
| D1120 |
Prophylaxis - child |
41,139 |
40,541 |
$1.20M |
| D0120 |
Periodic oral evaluation - established patient |
44,042 |
43,447 |
$896K |
| D1208 |
Topical application of fluoride, excluding varnish |
43,604 |
42,984 |
$634K |
| D1110 |
Prophylaxis - adult |
11,222 |
11,036 |
$485K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,629 |
3,234 |
$361K |
| D0330 |
Panoramic radiographic image |
7,695 |
7,626 |
$357K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,111 |
12,555 |
$340K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,567 |
2,570 |
$316K |
| D0272 |
Bitewings - two radiographic images |
17,535 |
17,254 |
$308K |
| D0274 |
Bitewings - four radiographic images |
10,062 |
9,884 |
$291K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,908 |
1,375 |
$256K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,200 |
5,053 |
$152K |
| D0140 |
Limited oral evaluation - problem focused |
4,188 |
4,103 |
$123K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,761 |
2,702 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
4,652 |
4,547 |
$68K |
| D2332 |
|
500 |
280 |
$52K |
| D3120 |
|
418 |
286 |
$12K |
| D2331 |
|
123 |
81 |
$10K |
| D2934 |
|
88 |
27 |
$10K |
| D2335 |
|
70 |
37 |
$8K |
| D2330 |
|
81 |
44 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
345 |
206 |
$3K |
| D2394 |
|
19 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
16 |
$1K |