| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,797 |
5,592 |
$948K |
| D0120 |
Periodic oral evaluation - established patient |
33,825 |
33,170 |
$893K |
| D1120 |
Prophylaxis - child |
32,689 |
31,984 |
$881K |
| D1206 |
Topical application of fluoride varnish |
41,338 |
40,428 |
$664K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,312 |
1,466 |
$605K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,453 |
11,833 |
$561K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,147 |
3,654 |
$420K |
| D1351 |
Sealant - per tooth |
13,201 |
4,918 |
$354K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,164 |
6,953 |
$319K |
| D0272 |
Bitewings - two radiographic images |
16,793 |
16,429 |
$305K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,976 |
943 |
$232K |
| D0140 |
Limited oral evaluation - problem focused |
6,003 |
5,832 |
$227K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,103 |
1,790 |
$199K |
| D0330 |
Panoramic radiographic image |
3,268 |
3,217 |
$185K |
| D1110 |
Prophylaxis - adult |
3,279 |
3,227 |
$127K |
| D9420 |
|
1,113 |
1,024 |
$126K |
| D0220 |
Intraoral - periapical first radiographic image |
4,886 |
4,682 |
$73K |
| D0274 |
Bitewings - four radiographic images |
605 |
597 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,732 |
758 |
$19K |
| D0240 |
|
700 |
623 |
$17K |
| D9110 |
|
43 |
42 |
$2K |
| D2330 |
|
24 |
14 |
$1K |
| D1353 |
|
796 |
476 |
$0.00 |