| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24,718 |
14,963 |
$1.55M |
| D1120 |
Prophylaxis - child |
40,551 |
40,543 |
$1.42M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,899 |
9,008 |
$1.14M |
| D1206 |
Topical application of fluoride varnish |
44,003 |
43,996 |
$941K |
| D0120 |
Periodic oral evaluation - established patient |
35,101 |
35,098 |
$793K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
8,540 |
6,770 |
$598K |
| D0272 |
Bitewings - two radiographic images |
35,955 |
35,946 |
$462K |
| D1351 |
Sealant - per tooth |
11,333 |
4,008 |
$365K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,100 |
6,105 |
$342K |
| D9920 |
|
15,578 |
13,788 |
$314K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,677 |
10,673 |
$247K |
| D1110 |
Prophylaxis - adult |
5,319 |
5,317 |
$225K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,725 |
4,183 |
$215K |
| D3240 |
|
1,090 |
998 |
$200K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,992 |
1,780 |
$156K |
| D0240 |
|
6,886 |
6,689 |
$126K |
| D0140 |
Limited oral evaluation - problem focused |
9,128 |
8,928 |
$101K |
| D0274 |
Bitewings - four radiographic images |
4,221 |
4,221 |
$89K |
| D0220 |
Intraoral - periapical first radiographic image |
6,963 |
6,866 |
$65K |
| D2335 |
|
608 |
522 |
$61K |
| D1320 |
|
4,853 |
4,853 |
$25K |
| D2332 |
|
219 |
140 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,004 |
1,004 |
$14K |
| D9310 |
|
191 |
191 |
$11K |
| D1510 |
|
117 |
104 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,050 |
1,046 |
$9K |
| D2931 |
|
79 |
71 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
133 |
133 |
$5K |
| D0330 |
Panoramic radiographic image |
188 |
187 |
$5K |
| D1515 |
|
27 |
25 |
$3K |
| D0270 |
|
166 |
166 |
$2K |
| D9440 |
|
64 |
62 |
$932.00 |
| D1999 |
|
17 |
17 |
$850.00 |
| D0602 |
|
235 |
235 |
$235.00 |
| D0601 |
|
151 |
151 |
$151.00 |
| D0603 |
|
97 |
97 |
$97.00 |