| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,733 |
4,850 |
$1.29M |
| D0120 |
Periodic oral evaluation - established patient |
44,711 |
42,898 |
$1.29M |
| D1120 |
Prophylaxis - child |
33,069 |
31,717 |
$1.15M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,670 |
2,201 |
$1.03M |
| D1206 |
Topical application of fluoride varnish |
34,920 |
33,373 |
$731K |
| D1310 |
|
16,480 |
15,701 |
$643K |
| D1110 |
Prophylaxis - adult |
11,598 |
11,067 |
$566K |
| D1330 |
|
16,489 |
15,709 |
$383K |
| D1351 |
Sealant - per tooth |
13,121 |
3,703 |
$377K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,806 |
2,110 |
$292K |
| D0272 |
Bitewings - two radiographic images |
11,986 |
11,480 |
$284K |
| D0330 |
Panoramic radiographic image |
4,095 |
3,926 |
$239K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,282 |
898 |
$235K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,226 |
6,750 |
$221K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,525 |
11,157 |
$209K |
| D0425 |
|
4,680 |
4,478 |
$198K |
| D0140 |
Limited oral evaluation - problem focused |
3,604 |
3,403 |
$130K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,595 |
957 |
$111K |
| D2929 |
|
515 |
195 |
$99K |
| D0350 |
|
3,174 |
3,019 |
$99K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
986 |
543 |
$96K |
| D0274 |
Bitewings - four radiographic images |
2,534 |
2,411 |
$91K |
| D0220 |
Intraoral - periapical first radiographic image |
5,089 |
4,817 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,022 |
1,950 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,469 |
2,298 |
$49K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,034 |
1,004 |
$36K |
| D0603 |
|
1,836 |
1,810 |
$22K |
| D9420 |
|
123 |
118 |
$11K |
| D0601 |
|
505 |
504 |
$6K |
| D9920 |
|
30 |
28 |
$1K |
| D1353 |
|
31 |
12 |
$798.98 |
| D2920 |
|
12 |
12 |
$641.40 |