| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,761 |
4,615 |
$1.31M |
| D0120 |
Periodic oral evaluation - established patient |
18,335 |
18,324 |
$448K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,995 |
2,262 |
$417K |
| D1206 |
Topical application of fluoride varnish |
20,171 |
20,156 |
$397K |
| D1110 |
Prophylaxis - adult |
8,232 |
8,224 |
$391K |
| D1120 |
Prophylaxis - child |
10,419 |
10,412 |
$357K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,615 |
1,097 |
$351K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,862 |
1,177 |
$302K |
| D1351 |
Sealant - per tooth |
5,564 |
1,712 |
$207K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,318 |
961 |
$202K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,863 |
1,090 |
$187K |
| D0220 |
Intraoral - periapical first radiographic image |
11,941 |
11,888 |
$153K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,570 |
4,375 |
$145K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,522 |
10,509 |
$138K |
| D0274 |
Bitewings - four radiographic images |
4,190 |
4,185 |
$127K |
| D0272 |
Bitewings - two radiographic images |
4,868 |
4,866 |
$101K |
| D0330 |
Panoramic radiographic image |
1,742 |
1,742 |
$91K |
| D0145 |
Oral evaluation for a patient under three years of age |
847 |
847 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
744 |
735 |
$27K |
| D3120 |
|
665 |
405 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
595 |
594 |
$24K |
| D0350 |
|
226 |
220 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
733 |
733 |
$19K |
| D2332 |
|
92 |
54 |
$14K |
| D1353 |
|
357 |
167 |
$13K |
| D2934 |
|
42 |
13 |
$7K |
| D2330 |
|
71 |
40 |
$7K |
| D3230 |
|
42 |
13 |
$5K |
| D9219 |
|
49 |
49 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
72 |
72 |
$882.99 |