| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,854 |
3,698 |
$462K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,563 |
1,361 |
$297K |
| D0120 |
Periodic oral evaluation - established patient |
10,708 |
10,348 |
$257K |
| D1120 |
Prophylaxis - child |
9,381 |
9,048 |
$197K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,523 |
1,839 |
$169K |
| D0272 |
Bitewings - two radiographic images |
11,581 |
11,171 |
$162K |
| D2934 |
|
1,293 |
499 |
$148K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,762 |
1,716 |
$143K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,423 |
1,074 |
$141K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,462 |
12,042 |
$141K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,550 |
1,206 |
$136K |
| D1351 |
Sealant - per tooth |
5,572 |
1,700 |
$107K |
| D1110 |
Prophylaxis - adult |
3,202 |
3,119 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,935 |
1,877 |
$75K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,150 |
1,978 |
$46K |
| D0330 |
Panoramic radiographic image |
1,028 |
984 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
874 |
872 |
$34K |
| D2330 |
|
651 |
407 |
$31K |
| D9310 |
|
781 |
779 |
$30K |
| D2332 |
|
411 |
285 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,230 |
1,148 |
$28K |
| D0240 |
|
1,304 |
1,251 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,523 |
1,467 |
$14K |
| D1510 |
|
112 |
84 |
$11K |
| D0274 |
Bitewings - four radiographic images |
36 |
36 |
$1K |
| D3120 |
|
15 |
13 |
$378.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$94.61 |