| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2929 |
|
13,340 |
3,915 |
$2.89M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32,848 |
16,929 |
$2.29M |
| D0120 |
Periodic oral evaluation - established patient |
76,327 |
73,033 |
$1.99M |
| D1120 |
Prophylaxis - child |
68,604 |
65,463 |
$1.56M |
| D1206 |
Topical application of fluoride varnish |
80,960 |
77,403 |
$1.54M |
| D7140 |
Extraction, erupted tooth or exposed root |
15,551 |
7,962 |
$853K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
33,101 |
27,608 |
$704K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,694 |
2,922 |
$639K |
| D9999 |
Unspecified adjunctive procedure, by report |
22,083 |
21,101 |
$634K |
| D1351 |
Sealant - per tooth |
26,996 |
8,370 |
$603K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
7,308 |
5,311 |
$554K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,994 |
5,705 |
$440K |
| D1110 |
Prophylaxis - adult |
11,520 |
11,046 |
$431K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,760 |
9,341 |
$390K |
| D2332 |
|
3,545 |
2,206 |
$320K |
| D0272 |
Bitewings - two radiographic images |
26,895 |
25,667 |
$261K |
| D0330 |
Panoramic radiographic image |
7,228 |
6,883 |
$260K |
| D0274 |
Bitewings - four radiographic images |
12,025 |
11,571 |
$165K |
| D0140 |
Limited oral evaluation - problem focused |
7,481 |
6,991 |
$154K |
| D3230 |
|
2,168 |
699 |
$143K |
| D0220 |
Intraoral - periapical first radiographic image |
15,557 |
14,230 |
$119K |
| D1999 |
|
8,542 |
7,784 |
$110K |
| D2330 |
|
1,755 |
1,120 |
$103K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
931 |
374 |
$98K |
| D9610 |
|
2,101 |
1,977 |
$86K |
| D0240 |
|
11,837 |
6,702 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,908 |
7,297 |
$41K |
| D3240 |
|
491 |
403 |
$33K |
| D1510 |
|
184 |
112 |
$9K |
| D2335 |
|
115 |
70 |
$6K |
| D1354 |
|
1,932 |
639 |
$6K |
| D0270 |
|
889 |
822 |
$5K |
| D9992 |
|
212 |
196 |
$3K |
| D1515 |
|
34 |
16 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
158 |
154 |
$2K |
| D9995 |
|
23 |
23 |
$230.00 |
| D3120 |
|
40 |
38 |
$0.00 |
| D0350 |
|
993 |
892 |
$0.00 |
| D9951 |
|
28 |
13 |
$0.00 |