| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,473 |
8,049 |
$1.85M |
| D1120 |
Prophylaxis - child |
43,857 |
38,823 |
$1.62M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,064 |
3,199 |
$1.55M |
| D0120 |
Periodic oral evaluation - established patient |
47,447 |
42,077 |
$1.12M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,685 |
6,811 |
$1.11M |
| D1208 |
Topical application of fluoride, excluding varnish |
52,321 |
46,350 |
$1.01M |
| D7140 |
Extraction, erupted tooth or exposed root |
12,138 |
4,401 |
$918K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17,790 |
15,273 |
$761K |
| D0272 |
Bitewings - two radiographic images |
25,698 |
22,634 |
$580K |
| D1110 |
Prophylaxis - adult |
8,815 |
7,900 |
$444K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,193 |
1,866 |
$380K |
| D0330 |
Panoramic radiographic image |
4,529 |
4,169 |
$254K |
| D0270 |
|
13,845 |
12,381 |
$254K |
| D0140 |
Limited oral evaluation - problem focused |
6,301 |
5,519 |
$227K |
| D1351 |
Sealant - per tooth |
7,763 |
2,608 |
$220K |
| D2330 |
|
2,122 |
1,185 |
$175K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,245 |
926 |
$168K |
| D9248 |
|
1,620 |
1,478 |
$164K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,323 |
3,888 |
$150K |
| D1354 |
|
2,806 |
1,514 |
$147K |
| D2332 |
|
1,151 |
697 |
$139K |
| D9310 |
|
2,354 |
2,105 |
$120K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,011 |
3,104 |
$107K |
| D0220 |
Intraoral - periapical first radiographic image |
6,610 |
5,799 |
$105K |
| D2932 |
|
739 |
199 |
$101K |
| D2929 |
|
670 |
205 |
$97K |
| D9420 |
|
2,096 |
1,840 |
$78K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,236 |
2,094 |
$57K |
| D9630 |
|
2,533 |
2,224 |
$48K |
| D2331 |
|
399 |
257 |
$39K |
| D0603 |
|
2,793 |
2,705 |
$37K |
| D0240 |
|
2,170 |
1,834 |
$36K |
| D1510 |
|
183 |
128 |
$27K |
| D0602 |
|
1,586 |
1,536 |
$17K |
| D1206 |
Topical application of fluoride varnish |
1,139 |
1,045 |
$15K |
| D2335 |
|
61 |
43 |
$9K |
| D1320 |
|
283 |
269 |
$9K |
| D0601 |
|
145 |
143 |
$1K |