| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34,849 |
14,208 |
$1.04M |
| D1120 |
Prophylaxis - child |
68,664 |
67,490 |
$872K |
| D0120 |
Periodic oral evaluation - established patient |
79,440 |
78,139 |
$670K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15,048 |
4,555 |
$630K |
| D1208 |
Topical application of fluoride, excluding varnish |
88,338 |
86,789 |
$534K |
| D7140 |
Extraction, erupted tooth or exposed root |
14,682 |
6,028 |
$394K |
| D0230 |
Intraoral - periapical each additional radiographic image |
92,854 |
79,692 |
$389K |
| D0220 |
Intraoral - periapical first radiographic image |
87,578 |
85,316 |
$386K |
| D0272 |
Bitewings - two radiographic images |
53,366 |
52,269 |
$366K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
9,351 |
5,065 |
$345K |
| D1110 |
Prophylaxis - adult |
20,828 |
20,411 |
$327K |
| D1999 |
|
25,426 |
23,276 |
$209K |
| D0274 |
Bitewings - four radiographic images |
20,627 |
20,201 |
$207K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,913 |
2,053 |
$183K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,177 |
2,843 |
$157K |
| D0330 |
Panoramic radiographic image |
9,650 |
9,344 |
$157K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,715 |
9,464 |
$140K |
| D2390 |
|
2,126 |
550 |
$129K |
| D9248 |
|
4,713 |
4,500 |
$128K |
| D1351 |
Sealant - per tooth |
14,444 |
4,440 |
$123K |
| D0140 |
Limited oral evaluation - problem focused |
9,130 |
8,833 |
$106K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,934 |
12,213 |
$88K |
| D1206 |
Topical application of fluoride varnish |
3,705 |
3,593 |
$27K |
| D2394 |
|
511 |
226 |
$19K |
| D3230 |
|
424 |
122 |
$13K |
| D2330 |
|
263 |
136 |
$6K |
| D2332 |
|
130 |
74 |
$6K |
| D0240 |
|
1,745 |
1,693 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
45 |
25 |
$2K |
| D2929 |
|
38 |
12 |
$1K |
| D3120 |
|
57 |
26 |
$748.16 |
| D0270 |
|
71 |
70 |
$322.17 |
| D0210 |
Intraoral - complete series of radiographic images |
79 |
75 |
$126.50 |
| D0170 |
|
14 |
13 |
$25.00 |
| D0601 |
|
4,418 |
3,796 |
$0.00 |
| D9994 |
|
2,402 |
2,291 |
$0.00 |
| D1330 |
|
2,046 |
1,919 |
$0.00 |