| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,490 |
7,320 |
$1.17M |
| D1120 |
Prophylaxis - child |
29,733 |
29,733 |
$1.04M |
| D7140 |
Extraction, erupted tooth or exposed root |
10,256 |
5,166 |
$926K |
| D0120 |
Periodic oral evaluation - established patient |
38,526 |
38,526 |
$899K |
| D9248 |
|
10,733 |
10,338 |
$747K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,862 |
6,597 |
$718K |
| D1110 |
Prophylaxis - adult |
14,279 |
14,279 |
$714K |
| D1206 |
Topical application of fluoride varnish |
43,469 |
43,469 |
$710K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17,709 |
16,953 |
$567K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,988 |
2,214 |
$370K |
| D0274 |
Bitewings - four radiographic images |
13,416 |
13,416 |
$365K |
| D0272 |
Bitewings - two radiographic images |
18,626 |
18,626 |
$347K |
| D0330 |
Panoramic radiographic image |
5,742 |
5,741 |
$263K |
| D1351 |
Sealant - per tooth |
6,260 |
1,624 |
$186K |
| D0220 |
Intraoral - periapical first radiographic image |
13,094 |
12,853 |
$170K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,348 |
7,150 |
$160K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,384 |
3,384 |
$139K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,007 |
755 |
$125K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,354 |
2,354 |
$101K |
| D0140 |
Limited oral evaluation - problem focused |
2,145 |
2,137 |
$82K |
| D7111 |
|
868 |
512 |
$57K |
| D2332 |
|
532 |
368 |
$56K |
| D1510 |
|
277 |
259 |
$47K |
| D2330 |
|
386 |
291 |
$25K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
178 |
134 |
$14K |
| D0240 |
|
41 |
25 |
$591.95 |