| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,293 |
4,631 |
$972K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,837 |
3,798 |
$616K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,502 |
23,572 |
$597K |
| D0120 |
Periodic oral evaluation - established patient |
23,746 |
23,498 |
$561K |
| D1110 |
Prophylaxis - adult |
10,256 |
10,168 |
$470K |
| D0274 |
Bitewings - four radiographic images |
13,794 |
13,629 |
$410K |
| D1206 |
Topical application of fluoride varnish |
20,001 |
19,764 |
$376K |
| D1120 |
Prophylaxis - child |
10,219 |
10,119 |
$336K |
| D0220 |
Intraoral - periapical first radiographic image |
25,505 |
25,166 |
$321K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,151 |
860 |
$186K |
| D4346 |
|
3,875 |
3,728 |
$176K |
| D0272 |
Bitewings - two radiographic images |
7,589 |
7,506 |
$158K |
| D1351 |
Sealant - per tooth |
4,525 |
1,564 |
$156K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,446 |
865 |
$143K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,365 |
4,034 |
$135K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,299 |
2,287 |
$91K |
| D0350 |
|
1,767 |
1,628 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
3,809 |
3,678 |
$74K |
| D4910 |
|
408 |
404 |
$34K |
| D4342 |
|
366 |
121 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
693 |
690 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,923 |
1,880 |
$22K |
| D0340 |
|
294 |
293 |
$17K |
| D8660 |
|
123 |
123 |
$16K |
| D2740 |
Crown - porcelain/ceramic |
18 |
12 |
$15K |
| D2950 |
|
60 |
51 |
$8K |
| D3120 |
|
203 |
149 |
$7K |
| D0351 |
|
197 |
196 |
$6K |
| D0470 |
|
121 |
121 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
32 |
26 |
$4K |
| D1353 |
|
30 |
12 |
$1K |
| D1330 |
|
12 |
12 |
$122.16 |