| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,961 |
8,508 |
$923K |
| D0120 |
Periodic oral evaluation - established patient |
26,043 |
24,445 |
$720K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,388 |
1,634 |
$691K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,966 |
6,193 |
$640K |
| D1208 |
Topical application of fluoride, excluding varnish |
28,088 |
26,230 |
$586K |
| D1120 |
Prophylaxis - child |
21,637 |
20,110 |
$498K |
| D1351 |
Sealant - per tooth |
16,653 |
5,346 |
$420K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16,654 |
15,327 |
$390K |
| D1110 |
Prophylaxis - adult |
6,987 |
6,618 |
$285K |
| D0272 |
Bitewings - two radiographic images |
24,221 |
22,670 |
$231K |
| D0330 |
Panoramic radiographic image |
5,862 |
5,473 |
$223K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,063 |
2,324 |
$220K |
| D9999 |
Unspecified adjunctive procedure, by report |
5,619 |
5,183 |
$176K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,098 |
1,724 |
$166K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,708 |
2,441 |
$113K |
| D0220 |
Intraoral - periapical first radiographic image |
12,221 |
11,272 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
2,388 |
2,226 |
$53K |
| D9630 |
|
1,063 |
999 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,919 |
6,720 |
$33K |
| D9920 |
|
992 |
930 |
$32K |
| D2332 |
|
271 |
187 |
$31K |
| D0240 |
|
2,585 |
1,256 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
164 |
91 |
$16K |
| D2331 |
|
151 |
92 |
$14K |
| D1206 |
Topical application of fluoride varnish |
381 |
381 |
$10K |
| D1354 |
|
1,928 |
459 |
$7K |
| D7240 |
Removal of impacted tooth - completely bony |
52 |
14 |
$7K |
| D2330 |
|
84 |
52 |
$6K |
| D7230 |
|
25 |
12 |
$3K |