| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,310 |
5,444 |
$1.36M |
| D1120 |
Prophylaxis - child |
13,783 |
13,701 |
$477K |
| D1206 |
Topical application of fluoride varnish |
24,341 |
24,214 |
$476K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,648 |
3,108 |
$474K |
| D0120 |
Periodic oral evaluation - established patient |
19,465 |
19,368 |
$470K |
| D1110 |
Prophylaxis - adult |
8,140 |
8,103 |
$379K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,857 |
890 |
$374K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,651 |
1,189 |
$257K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,030 |
7,699 |
$253K |
| D1351 |
Sealant - per tooth |
5,203 |
2,085 |
$187K |
| D0272 |
Bitewings - two radiographic images |
6,448 |
6,421 |
$135K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,351 |
399 |
$117K |
| D0274 |
Bitewings - four radiographic images |
3,156 |
3,150 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,253 |
2,235 |
$91K |
| D7240 |
Removal of impacted tooth - completely bony |
273 |
78 |
$77K |
| D7140 |
Extraction, erupted tooth or exposed root |
763 |
485 |
$77K |
| D0210 |
Intraoral - complete series of radiographic images |
879 |
857 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
4,848 |
4,790 |
$62K |
| D0330 |
Panoramic radiographic image |
927 |
911 |
$49K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,450 |
1,442 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,220 |
3,187 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
835 |
825 |
$29K |
| D9243 |
|
66 |
66 |
$18K |
| D0240 |
|
317 |
315 |
$12K |
| D9239 |
|
66 |
66 |
$7K |
| D7111 |
|
142 |
93 |
$7K |
| D9310 |
|
146 |
146 |
$6K |
| D2331 |
|
32 |
26 |
$4K |
| D9222 |
|
12 |
12 |
$1K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
12 |
12 |
$1K |