| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,100 |
5,649 |
$639K |
| D1120 |
Prophylaxis - child |
12,731 |
12,723 |
$586K |
| D0120 |
Periodic oral evaluation - established patient |
20,122 |
20,112 |
$523K |
| D1110 |
Prophylaxis - adult |
9,420 |
9,408 |
$431K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,901 |
10,901 |
$278K |
| D0140 |
Limited oral evaluation - problem focused |
3,968 |
3,857 |
$177K |
| D2740 |
Crown - porcelain/ceramic |
309 |
283 |
$167K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,388 |
1,784 |
$132K |
| D0274 |
Bitewings - four radiographic images |
7,862 |
7,849 |
$97K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
765 |
671 |
$65K |
| D0272 |
Bitewings - two radiographic images |
5,279 |
5,274 |
$54K |
| D1206 |
Topical application of fluoride varnish |
1,636 |
1,627 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,892 |
1,884 |
$49K |
| D1351 |
Sealant - per tooth |
2,106 |
365 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
823 |
628 |
$42K |
| D2954 |
|
355 |
338 |
$34K |
| D2332 |
|
477 |
289 |
$32K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
56 |
50 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
3,317 |
3,285 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,294 |
1,291 |
$11K |
| D0270 |
|
1,439 |
1,423 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
73 |
64 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
45 |
36 |
$4K |
| D2335 |
|
47 |
39 |
$4K |
| D0170 |
|
88 |
87 |
$4K |
| D3221 |
|
42 |
42 |
$2K |
| D0603 |
|
111 |
111 |
$1K |
| D0601 |
|
13 |
13 |
$130.00 |