| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,720 |
3,703 |
$453K |
| D1110 |
Prophylaxis - adult |
9,378 |
9,376 |
$446K |
| D0120 |
Periodic oral evaluation - established patient |
11,378 |
11,374 |
$290K |
| D1120 |
Prophylaxis - child |
6,474 |
6,472 |
$274K |
| D2752 |
|
410 |
286 |
$208K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,130 |
1,546 |
$192K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,853 |
2,047 |
$165K |
| D0210 |
Intraoral - complete series of radiographic images |
3,853 |
3,840 |
$142K |
| D0274 |
Bitewings - four radiographic images |
5,247 |
5,246 |
$133K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
719 |
413 |
$112K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,301 |
7,299 |
$101K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
797 |
412 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,831 |
2,830 |
$83K |
| D0330 |
Panoramic radiographic image |
2,651 |
2,650 |
$78K |
| D1351 |
Sealant - per tooth |
1,035 |
443 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
3,434 |
3,414 |
$45K |
| D1206 |
Topical application of fluoride varnish |
1,405 |
1,403 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,642 |
3,609 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
642 |
430 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,242 |
3,221 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
330 |
188 |
$27K |
| D2954 |
|
220 |
167 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,744 |
1,739 |
$26K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
41 |
41 |
$16K |
| D9310 |
|
319 |
319 |
$13K |
| D2394 |
|
91 |
73 |
$10K |
| D7111 |
|
100 |
81 |
$4K |
| D2332 |
|
25 |
14 |
$2K |
| D0270 |
|
139 |
138 |
$1K |
| D2331 |
|
15 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
43 |
43 |
$1K |
| D1999 |
|
533 |
513 |
$0.00 |