| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17,360 |
8,956 |
$1.40M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,904 |
6,043 |
$1.16M |
| D1120 |
Prophylaxis - child |
41,672 |
40,569 |
$1.15M |
| D0120 |
Periodic oral evaluation - established patient |
42,145 |
41,117 |
$1.11M |
| D1206 |
Topical application of fluoride varnish |
52,145 |
50,630 |
$849K |
| D1351 |
Sealant - per tooth |
27,525 |
6,538 |
$788K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,117 |
10,504 |
$490K |
| D0220 |
Intraoral - periapical first radiographic image |
27,564 |
26,685 |
$418K |
| D1110 |
Prophylaxis - adult |
10,533 |
10,291 |
$410K |
| D0330 |
Panoramic radiographic image |
6,410 |
6,215 |
$381K |
| D0272 |
Bitewings - two radiographic images |
18,152 |
17,655 |
$340K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,096 |
23,997 |
$307K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,908 |
4,684 |
$216K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,208 |
4,923 |
$185K |
| D0274 |
Bitewings - four radiographic images |
5,599 |
5,454 |
$183K |
| D0140 |
Limited oral evaluation - problem focused |
3,790 |
3,628 |
$142K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,258 |
1,423 |
$142K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
773 |
314 |
$109K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
730 |
503 |
$91K |
| D2330 |
|
984 |
704 |
$67K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
350 |
200 |
$27K |
| D2332 |
|
224 |
127 |
$20K |
| D2331 |
|
249 |
157 |
$20K |
| D9420 |
|
26 |
26 |
$3K |