| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,181 |
6,935 |
$2.68M |
| D0330 |
Panoramic radiographic image |
16,068 |
14,726 |
$1.40M |
| D1110 |
Prophylaxis - adult |
13,972 |
12,725 |
$1.07M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16,740 |
15,337 |
$979K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,341 |
3,648 |
$915K |
| D0274 |
Bitewings - four radiographic images |
17,313 |
15,832 |
$906K |
| D1351 |
Sealant - per tooth |
17,755 |
3,235 |
$797K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,908 |
18,439 |
$525K |
| D0120 |
Periodic oral evaluation - established patient |
12,272 |
11,457 |
$514K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,475 |
1,031 |
$420K |
| D1120 |
Prophylaxis - child |
4,316 |
4,083 |
$258K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,270 |
3,812 |
$219K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
896 |
507 |
$170K |
| D0220 |
Intraoral - periapical first radiographic image |
6,694 |
6,306 |
$150K |
| D2740 |
Crown - porcelain/ceramic |
157 |
118 |
$95K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
410 |
160 |
$90K |
| D2950 |
|
416 |
307 |
$71K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
142 |
39 |
$26K |
| D2331 |
|
166 |
98 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
387 |
355 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
673 |
258 |
$14K |
| D2752 |
|
16 |
13 |
$10K |
| D9243 |
|
52 |
12 |
$8K |
| D0272 |
Bitewings - two radiographic images |
155 |
148 |
$6K |
| D1206 |
Topical application of fluoride varnish |
169 |
166 |
$5K |
| D2335 |
|
16 |
13 |
$3K |