| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,518 |
2,213 |
$178K |
| D0120 |
Periodic oral evaluation - established patient |
8,248 |
7,991 |
$160K |
| D1120 |
Prophylaxis - child |
7,264 |
7,041 |
$128K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,536 |
1,656 |
$105K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,358 |
8,080 |
$80K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,094 |
3,657 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,062 |
1,984 |
$65K |
| D0272 |
Bitewings - two radiographic images |
5,335 |
5,165 |
$64K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
938 |
654 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,479 |
3,379 |
$45K |
| D1110 |
Prophylaxis - adult |
2,024 |
1,945 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
958 |
657 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
4,550 |
4,420 |
$35K |
| D1351 |
Sealant - per tooth |
2,262 |
795 |
$34K |
| D0330 |
Panoramic radiographic image |
1,281 |
1,276 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
1,478 |
1,340 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,908 |
1,839 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,950 |
1,910 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
588 |
578 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
186 |
146 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
392 |
388 |
$7K |
| D2330 |
|
39 |
12 |
$704.00 |
| D0270 |
|
13 |
13 |
$66.00 |