| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,581 |
2,397 |
$325K |
| D0120 |
Periodic oral evaluation - established patient |
7,171 |
6,822 |
$186K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,604 |
884 |
$183K |
| D1120 |
Prophylaxis - child |
5,762 |
5,497 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,324 |
1,325 |
$130K |
| D1110 |
Prophylaxis - adult |
2,987 |
2,828 |
$126K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,492 |
1,183 |
$116K |
| D0272 |
Bitewings - two radiographic images |
6,751 |
6,421 |
$101K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,862 |
697 |
$92K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
993 |
729 |
$89K |
| D2934 |
|
854 |
294 |
$86K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,639 |
6,301 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,558 |
1,495 |
$69K |
| D0274 |
Bitewings - four radiographic images |
1,083 |
1,042 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
1,424 |
1,324 |
$43K |
| D1351 |
Sealant - per tooth |
1,908 |
596 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,183 |
1,150 |
$34K |
| D0330 |
Panoramic radiographic image |
791 |
680 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,332 |
1,170 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
543 |
533 |
$23K |
| D2330 |
|
447 |
258 |
$21K |
| D2332 |
|
256 |
151 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,244 |
1,189 |
$18K |
| D0240 |
|
825 |
792 |
$11K |
| D1510 |
|
134 |
66 |
$8K |
| D9310 |
|
206 |
205 |
$7K |
| D3120 |
|
151 |
126 |
$5K |
| D2331 |
|
54 |
27 |
$3K |