| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,107 |
5,115 |
$1.69M |
| D1120 |
Prophylaxis - child |
26,329 |
23,441 |
$746K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,115 |
1,000 |
$681K |
| D1206 |
Topical application of fluoride varnish |
25,031 |
22,275 |
$551K |
| D1351 |
Sealant - per tooth |
20,890 |
3,407 |
$528K |
| D0120 |
Periodic oral evaluation - established patient |
17,166 |
16,062 |
$483K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,455 |
3,071 |
$457K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,139 |
1,996 |
$398K |
| D0330 |
Panoramic radiographic image |
6,851 |
6,044 |
$336K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,389 |
7,597 |
$308K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,740 |
945 |
$296K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,887 |
1,312 |
$236K |
| D0272 |
Bitewings - two radiographic images |
6,056 |
5,360 |
$114K |
| D0140 |
Limited oral evaluation - problem focused |
2,895 |
2,567 |
$112K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,610 |
6,458 |
$90K |
| D2934 |
|
429 |
88 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,159 |
2,759 |
$38K |
| D0350 |
|
1,652 |
1,411 |
$34K |
| D2330 |
|
326 |
127 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,806 |
1,539 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,322 |
1,189 |
$20K |
| D2335 |
|
285 |
106 |
$19K |
| D1110 |
Prophylaxis - adult |
199 |
191 |
$9K |
| D2394 |
|
33 |
27 |
$5K |
| D2332 |
|
31 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$835.68 |
| D1999 |
|
121 |
116 |
$0.00 |