| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,351 |
7,657 |
$1.59M |
| D7140 |
Extraction, erupted tooth or exposed root |
15,706 |
5,202 |
$1.01M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,455 |
2,404 |
$608K |
| D0230 |
Intraoral - periapical each additional radiographic image |
68,175 |
25,116 |
$495K |
| D0120 |
Periodic oral evaluation - established patient |
22,651 |
22,469 |
$457K |
| D0220 |
Intraoral - periapical first radiographic image |
29,918 |
29,689 |
$432K |
| D1110 |
Prophylaxis - adult |
9,276 |
9,229 |
$400K |
| D1120 |
Prophylaxis - child |
13,773 |
13,634 |
$400K |
| D1206 |
Topical application of fluoride varnish |
23,983 |
23,761 |
$371K |
| D9248 |
|
2,567 |
2,505 |
$332K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,693 |
3,457 |
$323K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,585 |
766 |
$301K |
| D0140 |
Limited oral evaluation - problem focused |
9,177 |
9,075 |
$261K |
| D0274 |
Bitewings - four radiographic images |
8,819 |
8,745 |
$256K |
| D1354 |
|
5,328 |
1,626 |
$256K |
| D0330 |
Panoramic radiographic image |
5,207 |
5,173 |
$247K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,200 |
7,944 |
$215K |
| D2332 |
|
1,978 |
1,101 |
$198K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
873 |
187 |
$103K |
| D2335 |
|
832 |
386 |
$96K |
| D1351 |
Sealant - per tooth |
3,992 |
1,412 |
$93K |
| D0272 |
Bitewings - two radiographic images |
3,909 |
3,870 |
$68K |
| D4341 |
|
440 |
126 |
$68K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
716 |
260 |
$62K |
| D0350 |
|
1,933 |
1,905 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,172 |
1,157 |
$31K |
| D0603 |
|
3,304 |
3,260 |
$30K |
| D9610 |
|
755 |
753 |
$22K |
| D2394 |
|
73 |
54 |
$11K |
| D7240 |
Removal of impacted tooth - completely bony |
37 |
12 |
$8K |
| D3120 |
|
225 |
126 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
406 |
406 |
$6K |
| D4342 |
|
31 |
12 |
$2K |
| D2331 |
|
25 |
15 |
$2K |
| D2330 |
|
37 |
28 |
$2K |
| D0602 |
|
237 |
237 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
28 |
28 |
$854.00 |
| D0210 |
Intraoral - complete series of radiographic images |
23 |
14 |
$756.27 |