| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,918 |
2,235 |
$389K |
| D1120 |
Prophylaxis - child |
10,135 |
10,135 |
$346K |
| D0120 |
Periodic oral evaluation - established patient |
9,361 |
9,361 |
$214K |
| D1206 |
Topical application of fluoride varnish |
12,856 |
12,856 |
$206K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,697 |
4,364 |
$150K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,919 |
1,330 |
$148K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,617 |
898 |
$144K |
| D1110 |
Prophylaxis - adult |
2,823 |
2,823 |
$136K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
999 |
408 |
$125K |
| D0272 |
Bitewings - two radiographic images |
6,392 |
6,392 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,629 |
2,629 |
$106K |
| D1351 |
Sealant - per tooth |
2,373 |
847 |
$68K |
| D0330 |
Panoramic radiographic image |
1,567 |
1,567 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
4,865 |
4,825 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,338 |
2,338 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,172 |
1,166 |
$44K |
| D0145 |
Oral evaluation for a patient under three years of age |
605 |
605 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,367 |
1,439 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
88 |
66 |
$11K |
| D0240 |
|
193 |
169 |
$3K |
| D9420 |
|
36 |
36 |
$3K |
| D9248 |
|
25 |
25 |
$2K |
| D9222 |
|
15 |
15 |
$1K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
14 |
14 |
$1K |