| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,363 |
5,973 |
$1.35M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,242 |
1,599 |
$770K |
| D1110 |
Prophylaxis - adult |
11,759 |
11,653 |
$624K |
| D0120 |
Periodic oral evaluation - established patient |
20,673 |
20,476 |
$581K |
| D1120 |
Prophylaxis - child |
13,756 |
13,649 |
$493K |
| D0230 |
Intraoral - periapical each additional radiographic image |
47,233 |
25,156 |
$473K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,930 |
3,268 |
$459K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,174 |
3,164 |
$445K |
| D1208 |
Topical application of fluoride, excluding varnish |
26,524 |
26,287 |
$380K |
| D0274 |
Bitewings - four radiographic images |
10,874 |
10,764 |
$353K |
| D1351 |
Sealant - per tooth |
12,227 |
2,810 |
$333K |
| D0220 |
Intraoral - periapical first radiographic image |
26,496 |
26,167 |
$304K |
| D9248 |
|
1,898 |
1,858 |
$224K |
| D7240 |
Removal of impacted tooth - completely bony |
770 |
264 |
$217K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,044 |
5,935 |
$203K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,346 |
1,012 |
$195K |
| D0210 |
Intraoral - complete series of radiographic images |
2,514 |
2,485 |
$167K |
| D0272 |
Bitewings - two radiographic images |
6,107 |
6,038 |
$127K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,427 |
1,335 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
334 |
204 |
$35K |
| D9243 |
|
946 |
343 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
496 |
321 |
$29K |
| D0170 |
|
1,998 |
1,981 |
$22K |
| D0330 |
Panoramic radiographic image |
809 |
790 |
$19K |
| D9239 |
|
343 |
343 |
$18K |
| D9310 |
|
912 |
909 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
371 |
367 |
$7K |
| D1330 |
|
641 |
618 |
$6K |
| D7111 |
|
454 |
257 |
$5K |
| D2330 |
|
65 |
40 |
$5K |
| D3120 |
|
52 |
42 |
$172.02 |
| D0603 |
|
24,543 |
24,362 |
$54.20 |
| D0601 |
|
994 |
982 |
$0.02 |
| D0602 |
|
5,406 |
5,363 |
$0.01 |