| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,571 |
8,747 |
$817K |
| D0120 |
Periodic oral evaluation - established patient |
34,304 |
32,399 |
$756K |
| D1120 |
Prophylaxis - child |
28,566 |
26,940 |
$612K |
| D1208 |
Topical application of fluoride, excluding varnish |
36,559 |
34,509 |
$547K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,189 |
1,224 |
$503K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,745 |
5,058 |
$373K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16,456 |
14,694 |
$312K |
| D1110 |
Prophylaxis - adult |
8,045 |
7,623 |
$273K |
| D0272 |
Bitewings - two radiographic images |
27,822 |
26,219 |
$267K |
| D0330 |
Panoramic radiographic image |
5,994 |
5,679 |
$237K |
| D1351 |
Sealant - per tooth |
10,687 |
3,785 |
$223K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,326 |
1,975 |
$184K |
| D9999 |
Unspecified adjunctive procedure, by report |
5,658 |
5,294 |
$145K |
| D1999 |
|
7,757 |
7,479 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,064 |
1,924 |
$73K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
676 |
582 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
5,944 |
5,575 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
2,064 |
1,913 |
$38K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
387 |
180 |
$31K |
| D0240 |
|
1,931 |
963 |
$16K |
| D2331 |
|
178 |
118 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,708 |
1,767 |
$8K |
| D2330 |
|
82 |
51 |
$5K |
| D7240 |
Removal of impacted tooth - completely bony |
190 |
38 |
$4K |
| D7111 |
|
114 |
69 |
$3K |
| D9920 |
|
78 |
78 |
$2K |
| D1354 |
|
214 |
67 |
$603.00 |