| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,089 |
3,702 |
$501K |
| D1110 |
Prophylaxis - adult |
8,648 |
8,120 |
$418K |
| D0120 |
Periodic oral evaluation - established patient |
10,888 |
10,207 |
$247K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,584 |
1,517 |
$223K |
| D1351 |
Sealant - per tooth |
7,394 |
1,673 |
$196K |
| D0274 |
Bitewings - four radiographic images |
5,313 |
4,947 |
$180K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,791 |
9,122 |
$172K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,876 |
944 |
$151K |
| D1120 |
Prophylaxis - child |
4,563 |
4,230 |
$140K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,198 |
1,479 |
$124K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,511 |
3,785 |
$121K |
| D0210 |
Intraoral - complete series of radiographic images |
2,421 |
2,287 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,873 |
2,648 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
2,342 |
2,099 |
$78K |
| D0272 |
Bitewings - two radiographic images |
2,588 |
2,381 |
$55K |
| D9920 |
|
1,388 |
1,172 |
$52K |
| D0330 |
Panoramic radiographic image |
1,289 |
1,148 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
2,468 |
2,254 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
133 |
45 |
$24K |
| D2394 |
|
125 |
105 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
450 |
228 |
$4K |
| D0240 |
|
121 |
62 |
$2K |
| D2331 |
|
18 |
12 |
$2K |
| D2330 |
|
19 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
351 |
328 |
$1K |
| D0270 |
|
28 |
26 |
$532.58 |
| D0431 |
|
884 |
831 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
30 |
16 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
28 |
16 |
$0.00 |