| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,694 |
7,363 |
$1.84M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
7,209 |
3,834 |
$866K |
| D1120 |
Prophylaxis - child |
25,999 |
25,999 |
$783K |
| D0120 |
Periodic oral evaluation - established patient |
36,882 |
36,881 |
$774K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,453 |
1,115 |
$660K |
| D1110 |
Prophylaxis - adult |
13,472 |
13,472 |
$605K |
| D0330 |
Panoramic radiographic image |
12,084 |
12,084 |
$584K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,820 |
4,039 |
$584K |
| D1208 |
Topical application of fluoride, excluding varnish |
36,953 |
36,953 |
$555K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,513 |
2,047 |
$486K |
| D0274 |
Bitewings - four radiographic images |
13,679 |
13,679 |
$412K |
| D0140 |
Limited oral evaluation - problem focused |
8,914 |
8,874 |
$268K |
| D4341 |
|
1,660 |
599 |
$240K |
| D0220 |
Intraoral - periapical first radiographic image |
15,564 |
15,340 |
$233K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,672 |
2,008 |
$218K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,888 |
7,721 |
$213K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,097 |
6,097 |
$184K |
| D0272 |
Bitewings - two radiographic images |
9,770 |
9,770 |
$177K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
600 |
599 |
$162K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,116 |
409 |
$102K |
| D7111 |
|
1,042 |
719 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,963 |
5,100 |
$61K |
| D9610 |
|
1,389 |
1,386 |
$42K |
| D7240 |
Removal of impacted tooth - completely bony |
169 |
68 |
$36K |
| D7230 |
|
173 |
82 |
$30K |
| D4910 |
|
550 |
550 |
$28K |
| D2332 |
|
238 |
153 |
$24K |
| D1206 |
Topical application of fluoride varnish |
945 |
945 |
$17K |
| D9248 |
|
99 |
99 |
$13K |
| D4342 |
|
77 |
24 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
92 |
92 |
$3K |
| D0603 |
|
248 |
248 |
$2K |
| D2335 |
|
25 |
13 |
$2K |
| D0602 |
|
155 |
155 |
$1K |