| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,944 |
5,234 |
$1.59M |
| D1120 |
Prophylaxis - child |
26,238 |
25,130 |
$976K |
| D1206 |
Topical application of fluoride varnish |
34,447 |
32,389 |
$728K |
| D0120 |
Periodic oral evaluation - established patient |
26,615 |
25,335 |
$716K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,964 |
1,583 |
$541K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,217 |
3,396 |
$449K |
| D1351 |
Sealant - per tooth |
14,336 |
3,689 |
$443K |
| D8670 |
Periodic orthodontic treatment visit |
5,205 |
4,755 |
$416K |
| D1110 |
Prophylaxis - adult |
7,159 |
6,689 |
$388K |
| D1310 |
|
9,705 |
8,867 |
$377K |
| D0350 |
|
16,864 |
14,787 |
$309K |
| D0330 |
Panoramic radiographic image |
4,468 |
4,284 |
$263K |
| D0272 |
Bitewings - two radiographic images |
10,092 |
9,684 |
$230K |
| D1330 |
|
9,048 |
8,290 |
$207K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,634 |
1,229 |
$201K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,769 |
5,115 |
$183K |
| D0603 |
|
17,791 |
16,188 |
$181K |
| D0274 |
Bitewings - four radiographic images |
4,309 |
4,075 |
$156K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
726 |
421 |
$126K |
| D0220 |
Intraoral - periapical first radiographic image |
6,794 |
6,414 |
$119K |
| D0425 |
|
2,578 |
2,417 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,878 |
2,762 |
$104K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,677 |
2,550 |
$94K |
| D9420 |
|
884 |
847 |
$80K |
| D0140 |
Limited oral evaluation - problem focused |
2,073 |
1,973 |
$76K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
735 |
359 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,598 |
2,983 |
$46K |
| D2932 |
|
200 |
57 |
$30K |
| D9310 |
|
454 |
441 |
$24K |
| D1353 |
|
517 |
165 |
$17K |
| D2332 |
|
103 |
62 |
$13K |
| D0240 |
|
501 |
434 |
$12K |
| D1515 |
|
32 |
24 |
$5K |
| D2330 |
|
76 |
49 |
$5K |
| D0601 |
|
522 |
501 |
$5K |
| D0460 |
|
153 |
136 |
$4K |
| D1516 |
|
15 |
14 |
$2K |
| D0340 |
|
40 |
40 |
$2K |
| D0602 |
|
189 |
189 |
$2K |
| D2331 |
|
16 |
12 |
$2K |
| D0171 |
|
227 |
189 |
$1K |
| D0470 |
|
40 |
40 |
$1K |
| D7111 |
|
16 |
12 |
$1K |
| D1354 |
|
35 |
13 |
$550.48 |
| D1555 |
|
15 |
13 |
$546.83 |
| D1999 |
|
2,485 |
2,373 |
$137.88 |