| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,342 |
3,714 |
$857K |
| D1120 |
Prophylaxis - child |
23,204 |
22,667 |
$778K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,456 |
1,343 |
$736K |
| D1206 |
Topical application of fluoride varnish |
32,375 |
31,309 |
$717K |
| D0120 |
Periodic oral evaluation - established patient |
25,068 |
24,463 |
$654K |
| D0272 |
Bitewings - two radiographic images |
18,327 |
17,968 |
$424K |
| D1351 |
Sealant - per tooth |
11,923 |
3,516 |
$335K |
| D1310 |
|
8,561 |
8,331 |
$326K |
| D1110 |
Prophylaxis - adult |
4,999 |
4,891 |
$262K |
| D1330 |
|
8,875 |
8,653 |
$215K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,726 |
5,419 |
$173K |
| D0603 |
|
15,777 |
15,032 |
$158K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,418 |
4,332 |
$155K |
| D0274 |
Bitewings - four radiographic images |
2,919 |
2,870 |
$115K |
| D0330 |
Panoramic radiographic image |
1,915 |
1,879 |
$113K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,384 |
648 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,548 |
1,093 |
$109K |
| D0601 |
|
9,776 |
9,571 |
$99K |
| D0602 |
|
8,803 |
8,608 |
$89K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,482 |
2,418 |
$79K |
| D0240 |
|
2,371 |
1,259 |
$46K |
| D0425 |
|
1,156 |
1,109 |
$45K |
| D9310 |
|
600 |
587 |
$30K |
| D2929 |
|
104 |
28 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,016 |
652 |
$17K |
| D9420 |
|
145 |
143 |
$13K |
| D1354 |
|
657 |
206 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
115 |
115 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
174 |
172 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
15 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
102 |
96 |
$2K |
| D9630 |
|
98 |
94 |
$1K |
| D3120 |
|
43 |
24 |
$1K |
| D2330 |
|
16 |
12 |
$1K |
| D0171 |
|
12 |
12 |
$309.96 |