| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,619 |
7,967 |
$1.29M |
| D0120 |
Periodic oral evaluation - established patient |
35,168 |
33,217 |
$872K |
| D1110 |
Prophylaxis - adult |
20,005 |
18,680 |
$735K |
| D1206 |
Topical application of fluoride varnish |
35,846 |
33,814 |
$558K |
| D1120 |
Prophylaxis - child |
19,988 |
19,078 |
$534K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,082 |
9,415 |
$469K |
| D0230 |
Intraoral - periapical each additional radiographic image |
41,674 |
19,333 |
$433K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,114 |
2,252 |
$382K |
| D0220 |
Intraoral - periapical first radiographic image |
24,089 |
22,569 |
$348K |
| D0274 |
Bitewings - four radiographic images |
11,434 |
10,719 |
$347K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,049 |
2,928 |
$305K |
| D0330 |
Panoramic radiographic image |
4,991 |
4,720 |
$267K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,848 |
5,488 |
$246K |
| D1351 |
Sealant - per tooth |
6,299 |
1,681 |
$164K |
| D0272 |
Bitewings - two radiographic images |
8,950 |
8,542 |
$157K |
| D0140 |
Limited oral evaluation - problem focused |
2,532 |
2,349 |
$88K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,346 |
733 |
$83K |
| D0240 |
|
3,854 |
1,881 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
683 |
639 |
$45K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
219 |
142 |
$29K |
| D2335 |
|
198 |
137 |
$24K |
| D2332 |
|
206 |
133 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
163 |
75 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
174 |
118 |
$14K |
| D2394 |
|
122 |
53 |
$11K |
| D4341 |
|
95 |
26 |
$5K |
| D2330 |
|
56 |
39 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
98 |
97 |
$3K |
| D2950 |
|
18 |
13 |
$1K |
| D7111 |
|
12 |
12 |
$605.71 |
| D1999 |
|
48 |
48 |
$0.00 |