| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28,702 |
17,684 |
$3.02M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31,237 |
17,799 |
$2.46M |
| D0120 |
Periodic oral evaluation - established patient |
68,226 |
66,541 |
$1.76M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,412 |
6,599 |
$1.65M |
| D1120 |
Prophylaxis - child |
53,712 |
52,157 |
$1.45M |
| D1206 |
Topical application of fluoride varnish |
67,173 |
65,221 |
$1.09M |
| D1110 |
Prophylaxis - adult |
25,522 |
24,731 |
$963K |
| D1351 |
Sealant - per tooth |
30,545 |
8,445 |
$849K |
| D0220 |
Intraoral - periapical first radiographic image |
45,966 |
44,560 |
$686K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,604 |
3,479 |
$582K |
| D0330 |
Panoramic radiographic image |
10,989 |
10,683 |
$532K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,859 |
5,031 |
$496K |
| D0274 |
Bitewings - four radiographic images |
15,022 |
14,563 |
$464K |
| D0272 |
Bitewings - two radiographic images |
24,719 |
24,101 |
$441K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,401 |
7,086 |
$319K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,919 |
20,281 |
$263K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,697 |
1,833 |
$218K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,636 |
11,413 |
$180K |
| D0140 |
Limited oral evaluation - problem focused |
3,519 |
3,364 |
$129K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,908 |
2,150 |
$78K |
| D2934 |
|
387 |
191 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
953 |
880 |
$40K |
| D7111 |
|
600 |
440 |
$32K |
| D2330 |
|
318 |
233 |
$21K |
| D9420 |
|
150 |
147 |
$18K |
| D2332 |
|
32 |
25 |
$3K |
| D1510 |
|
14 |
14 |
$3K |
| D2140 |
|
22 |
16 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
13 |
$2K |
| D9440 |
|
23 |
23 |
$1K |
| D9996 |
|
13 |
13 |
$254.10 |
| D0350 |
|
2,591 |
2,444 |
$22.00 |
| D1999 |
|
234 |
224 |
$0.00 |