| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,039 |
1,754 |
$22K |
| D1120 |
Prophylaxis - child |
7,433 |
7,223 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
9,022 |
8,778 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,719 |
9,424 |
$10K |
| D1110 |
Prophylaxis - adult |
2,707 |
2,605 |
$6K |
| D0272 |
Bitewings - two radiographic images |
5,173 |
4,987 |
$6K |
| D0274 |
Bitewings - four radiographic images |
3,666 |
3,554 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,080 |
1,040 |
$5K |
| D0330 |
Panoramic radiographic image |
1,445 |
1,392 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
5,404 |
5,207 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,945 |
4,674 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,757 |
2,343 |
$2K |
| D1351 |
Sealant - per tooth |
1,519 |
474 |
$2K |
| D0240 |
|
1,612 |
1,489 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
274 |
146 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
160 |
149 |
$572.69 |
| D0145 |
Oral evaluation for a patient under three years of age |
284 |
280 |
$534.01 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
33 |
14 |
$512.92 |
| D1206 |
Topical application of fluoride varnish |
154 |
152 |
$297.42 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
58 |
35 |
$200.00 |
| D1354 |
|
323 |
84 |
$170.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
12 |
$106.34 |
| D0210 |
Intraoral - complete series of radiographic images |
59 |
57 |
$56.00 |
| D1999 |
|
1,644 |
1,412 |
$0.00 |
| D9248 |
|
56 |
49 |
$0.00 |
| D0601 |
|
729 |
650 |
$0.00 |
| D0603 |
|
315 |
286 |
$0.00 |