| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,977 |
5,138 |
$966K |
| D0120 |
Periodic oral evaluation - established patient |
22,194 |
21,802 |
$647K |
| D1110 |
Prophylaxis - adult |
12,218 |
11,967 |
$625K |
| D1120 |
Prophylaxis - child |
15,133 |
14,864 |
$560K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,290 |
21,847 |
$468K |
| D0272 |
Bitewings - two radiographic images |
15,522 |
15,204 |
$345K |
| D1351 |
Sealant - per tooth |
9,232 |
2,839 |
$303K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,901 |
5,747 |
$292K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,061 |
1,424 |
$285K |
| D0330 |
Panoramic radiographic image |
4,633 |
4,504 |
$266K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,226 |
2,325 |
$244K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,069 |
482 |
$200K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,822 |
1,104 |
$138K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,037 |
721 |
$91K |
| D0220 |
Intraoral - periapical first radiographic image |
6,302 |
5,944 |
$86K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,359 |
1,346 |
$75K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,625 |
1,376 |
$67K |
| D2140 |
|
774 |
584 |
$52K |
| D2332 |
|
280 |
172 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,329 |
1,524 |
$26K |
| D2335 |
|
88 |
57 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
1,243 |
1,201 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
127 |
89 |
$14K |
| D2931 |
|
31 |
25 |
$9K |
| D2160 |
|
41 |
36 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
55 |
55 |
$4K |
| D2330 |
|
22 |
13 |
$3K |
| D9986 |
|
27 |
26 |
$0.00 |