| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,601 |
1,353 |
$245K |
| D1120 |
Prophylaxis - child |
6,701 |
5,944 |
$173K |
| D1351 |
Sealant - per tooth |
6,820 |
1,522 |
$169K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,008 |
921 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
5,305 |
4,750 |
$128K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,878 |
6,074 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,326 |
777 |
$95K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
775 |
342 |
$91K |
| D0330 |
Panoramic radiographic image |
1,726 |
1,527 |
$80K |
| D0272 |
Bitewings - two radiographic images |
3,373 |
2,964 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,116 |
956 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,359 |
1,191 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,266 |
1,060 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
1,230 |
1,103 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
126 |
67 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
24 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
328 |
230 |
$3K |
| D2330 |
|
22 |
14 |
$1K |