| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,533 |
2,158 |
$843K |
| D1120 |
Prophylaxis - child |
8,104 |
7,944 |
$432K |
| D0120 |
Periodic oral evaluation - established patient |
9,955 |
9,626 |
$419K |
| D1206 |
Topical application of fluoride varnish |
10,061 |
9,876 |
$328K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,791 |
3,527 |
$281K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,197 |
960 |
$234K |
| D1110 |
Prophylaxis - adult |
3,217 |
3,168 |
$234K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,131 |
579 |
$192K |
| D0274 |
Bitewings - four radiographic images |
2,868 |
2,799 |
$147K |
| D0272 |
Bitewings - two radiographic images |
3,778 |
3,696 |
$140K |
| D0330 |
Panoramic radiographic image |
1,637 |
1,601 |
$138K |
| D1351 |
Sealant - per tooth |
3,167 |
639 |
$136K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,106 |
1,320 |
$67K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
258 |
72 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
2,434 |
2,366 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,046 |
919 |
$60K |
| D0240 |
|
2,157 |
775 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
742 |
719 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
182 |
180 |
$11K |
| D0270 |
|
251 |
250 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
42 |
40 |
$2K |
| D1999 |
|
1,602 |
1,462 |
$0.00 |
| D0603 |
|
5,850 |
5,729 |
$0.00 |
| D1330 |
|
10,302 |
10,114 |
$0.00 |
| D9420 |
|
57 |
53 |
$0.00 |
| D0602 |
|
5,485 |
5,389 |
$0.00 |