| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,811 |
2,055 |
$278K |
| D1110 |
Prophylaxis - adult |
6,253 |
6,183 |
$241K |
| D1120 |
Prophylaxis - child |
8,453 |
8,395 |
$233K |
| D0120 |
Periodic oral evaluation - established patient |
10,660 |
10,554 |
$176K |
| D1206 |
Topical application of fluoride varnish |
9,986 |
9,857 |
$157K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,276 |
842 |
$117K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,535 |
950 |
$99K |
| D1354 |
|
3,825 |
1,013 |
$93K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,526 |
4,526 |
$91K |
| D0274 |
Bitewings - four radiographic images |
3,517 |
3,474 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
2,903 |
2,236 |
$78K |
| D0272 |
Bitewings - two radiographic images |
4,062 |
4,030 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,444 |
2,417 |
$64K |
| D1351 |
Sealant - per tooth |
2,134 |
691 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,159 |
1,873 |
$57K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
181 |
54 |
$21K |
| D9920 |
|
253 |
253 |
$17K |
| D0330 |
Panoramic radiographic image |
310 |
310 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
652 |
634 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
644 |
636 |
$6K |
| D2332 |
|
57 |
25 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
234 |
234 |
$3K |
| D9630 |
|
115 |
115 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
26 |
14 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
75 |
75 |
$2K |
| D2140 |
|
18 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
82 |
36 |
$988.20 |