| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25,129 |
14,709 |
$1.82M |
| D0120 |
Periodic oral evaluation - established patient |
43,704 |
43,265 |
$1.04M |
| D1206 |
Topical application of fluoride varnish |
49,860 |
49,332 |
$1.03M |
| D1120 |
Prophylaxis - child |
30,564 |
30,225 |
$990K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15,717 |
9,933 |
$940K |
| D1110 |
Prophylaxis - adult |
22,002 |
21,756 |
$899K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
6,955 |
5,033 |
$573K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19,662 |
18,596 |
$564K |
| D0274 |
Bitewings - four radiographic images |
16,789 |
16,597 |
$387K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
720 |
637 |
$374K |
| D0220 |
Intraoral - periapical first radiographic image |
32,871 |
31,856 |
$367K |
| D0330 |
Panoramic radiographic image |
11,166 |
11,032 |
$345K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,531 |
11,390 |
$326K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,769 |
2,372 |
$272K |
| D1351 |
Sealant - per tooth |
8,801 |
3,300 |
$251K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,875 |
25,129 |
$214K |
| D0272 |
Bitewings - two radiographic images |
10,079 |
9,963 |
$156K |
| D2950 |
|
1,326 |
984 |
$123K |
| D0140 |
Limited oral evaluation - problem focused |
5,422 |
5,346 |
$122K |
| D0210 |
Intraoral - complete series of radiographic images |
2,096 |
2,071 |
$115K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,001 |
774 |
$110K |
| D2394 |
|
1,050 |
803 |
$89K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
992 |
786 |
$80K |
| D4346 |
|
1,433 |
1,418 |
$60K |
| D2332 |
|
485 |
345 |
$41K |
| D2330 |
|
654 |
471 |
$39K |
| D2335 |
|
437 |
266 |
$39K |
| D2331 |
|
460 |
354 |
$34K |
| D2740 |
Crown - porcelain/ceramic |
56 |
40 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
137 |
76 |
$18K |
| D3320 |
|
26 |
25 |
$13K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
20 |
14 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
469 |
464 |
$9K |
| D9248 |
|
89 |
83 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
346 |
345 |
$7K |
| D1353 |
|
190 |
79 |
$5K |
| D2931 |
|
13 |
12 |
$2K |
| D2954 |
|
17 |
12 |
$2K |
| D7111 |
|
203 |
137 |
$197.52 |
| D0701 |
|
26 |
26 |
$0.00 |