| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,345 |
1,073 |
$38K |
| D1120 |
Prophylaxis - child |
3,579 |
3,497 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,532 |
4,032 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,754 |
1,715 |
$17K |
| D1206 |
Topical application of fluoride varnish |
4,100 |
4,024 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
5,176 |
4,912 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
2,932 |
2,830 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
408 |
92 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
751 |
451 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,756 |
1,717 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
1,158 |
1,097 |
$7K |
| D1110 |
Prophylaxis - adult |
1,021 |
982 |
$7K |
| D0274 |
Bitewings - four radiographic images |
1,196 |
1,134 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
579 |
534 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
167 |
95 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
119 |
52 |
$2K |
| D0330 |
Panoramic radiographic image |
313 |
306 |
$2K |
| D1351 |
Sealant - per tooth |
632 |
206 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
17 |
$1K |
| D0603 |
|
1,078 |
1,052 |
$0.00 |
| D0602 |
|
530 |
521 |
$0.00 |
| D0601 |
|
246 |
243 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
12 |
$0.00 |