| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,213 |
3,211 |
$841K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,147 |
1,358 |
$227K |
| D0120 |
Periodic oral evaluation - established patient |
7,209 |
7,182 |
$165K |
| D1110 |
Prophylaxis - adult |
3,560 |
3,554 |
$148K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,478 |
761 |
$145K |
| D1120 |
Prophylaxis - child |
4,306 |
4,255 |
$135K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
693 |
470 |
$111K |
| D1206 |
Topical application of fluoride varnish |
5,565 |
5,505 |
$96K |
| D0220 |
Intraoral - periapical first radiographic image |
7,699 |
7,601 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,095 |
6,989 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,335 |
2,323 |
$89K |
| D0210 |
Intraoral - complete series of radiographic images |
1,328 |
1,318 |
$87K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
659 |
208 |
$81K |
| D0274 |
Bitewings - four radiographic images |
2,224 |
2,220 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,911 |
1,783 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
1,475 |
1,449 |
$49K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
289 |
188 |
$45K |
| D0272 |
Bitewings - two radiographic images |
2,122 |
2,112 |
$44K |
| D1351 |
Sealant - per tooth |
1,160 |
445 |
$40K |
| D4910 |
|
358 |
353 |
$24K |
| D0180 |
|
525 |
525 |
$22K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
221 |
68 |
$19K |
| D0330 |
Panoramic radiographic image |
110 |
110 |
$6K |
| D3120 |
|
115 |
50 |
$4K |
| D2950 |
|
31 |
27 |
$4K |
| D4342 |
|
41 |
17 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
183 |
183 |
$2K |
| D2330 |
|
20 |
12 |
$2K |
| D4346 |
|
37 |
37 |
$2K |