| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,626 |
2,743 |
$615K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,385 |
2,621 |
$455K |
| D0120 |
Periodic oral evaluation - established patient |
12,688 |
12,540 |
$302K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,696 |
12,496 |
$299K |
| D1206 |
Topical application of fluoride varnish |
15,282 |
15,079 |
$291K |
| D1110 |
Prophylaxis - adult |
5,498 |
5,425 |
$250K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,264 |
6,742 |
$227K |
| D1120 |
Prophylaxis - child |
6,743 |
6,669 |
$226K |
| D0220 |
Intraoral - periapical first radiographic image |
13,282 |
13,093 |
$168K |
| D0274 |
Bitewings - four radiographic images |
3,110 |
3,065 |
$90K |
| D0272 |
Bitewings - two radiographic images |
3,359 |
3,315 |
$71K |
| D0190 |
|
2,296 |
2,249 |
$39K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
247 |
107 |
$31K |
| D1351 |
Sealant - per tooth |
807 |
343 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
1,129 |
1,113 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
158 |
95 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
293 |
293 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
55 |
42 |
$9K |
| D1354 |
|
317 |
106 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
157 |
149 |
$5K |
| D0330 |
Panoramic radiographic image |
90 |
90 |
$5K |
| D1352 |
|
110 |
75 |
$3K |
| D1353 |
|
50 |
27 |
$2K |