| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,857 |
2,798 |
$708K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,201 |
1,621 |
$661K |
| D1120 |
Prophylaxis - child |
15,533 |
12,770 |
$507K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,666 |
2,446 |
$467K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,102 |
1,913 |
$442K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,548 |
12,794 |
$281K |
| D1351 |
Sealant - per tooth |
9,967 |
2,788 |
$268K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,074 |
879 |
$182K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,585 |
3,638 |
$178K |
| D0120 |
Periodic oral evaluation - established patient |
7,930 |
6,454 |
$176K |
| D0240 |
|
9,426 |
7,549 |
$140K |
| D0220 |
Intraoral - periapical first radiographic image |
10,403 |
8,387 |
$130K |
| D0330 |
Panoramic radiographic image |
1,904 |
1,640 |
$103K |
| D0274 |
Bitewings - four radiographic images |
3,404 |
2,640 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,942 |
2,387 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,113 |
2,708 |
$82K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
635 |
369 |
$79K |
| D0272 |
Bitewings - two radiographic images |
4,780 |
4,035 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
1,061 |
946 |
$73K |
| D1110 |
Prophylaxis - adult |
1,345 |
1,124 |
$65K |
| D9630 |
|
4,151 |
3,551 |
$64K |
| D1354 |
|
1,199 |
332 |
$60K |
| D9420 |
|
1,806 |
1,471 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,338 |
1,101 |
$44K |
| D2332 |
|
348 |
172 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,352 |
1,122 |
$26K |
| D9310 |
|
380 |
346 |
$18K |
| D2335 |
|
40 |
24 |
$6K |
| D2331 |
|
34 |
25 |
$4K |
| D2330 |
|
16 |
12 |
$1K |
| D1353 |
|
146 |
56 |
$907.50 |
| D0273 |
|
78 |
76 |
$61.50 |
| D0270 |
|
157 |
76 |
$40.30 |
| D0603 |
|
1,028 |
937 |
$0.00 |
| D1330 |
|
3,161 |
2,810 |
$0.00 |
| D0602 |
|
3,552 |
3,151 |
$0.00 |
| D0601 |
|
16 |
16 |
$0.00 |