| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,205 |
2,185 |
$115K |
| D1120 |
Prophylaxis - child |
9,294 |
9,141 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
10,215 |
10,111 |
$81K |
| D1206 |
Topical application of fluoride varnish |
9,321 |
9,180 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
9,647 |
9,466 |
$38K |
| D0274 |
Bitewings - four radiographic images |
4,257 |
4,203 |
$33K |
| D1351 |
Sealant - per tooth |
4,727 |
1,692 |
$31K |
| D1110 |
Prophylaxis - adult |
2,429 |
2,364 |
$29K |
| D0272 |
Bitewings - two radiographic images |
4,065 |
4,001 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,184 |
817 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,605 |
1,552 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
1,023 |
982 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,793 |
2,763 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,528 |
3,810 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,547 |
1,421 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
80 |
40 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
419 |
403 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
180 |
126 |
$3K |
| D0240 |
|
490 |
475 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
135 |
96 |
$2K |
| D0330 |
Panoramic radiographic image |
175 |
165 |
$2K |
| D2332 |
|
23 |
15 |
$683.40 |
| D0602 |
|
950 |
894 |
$0.00 |
| D0603 |
|
888 |
822 |
$0.00 |
| D0601 |
|
900 |
849 |
$0.00 |
| D1999 |
|
3,495 |
2,539 |
$0.00 |
| D1354 |
|
33 |
12 |
$0.00 |