| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,787 |
2,802 |
$491K |
| D0120 |
Periodic oral evaluation - established patient |
11,820 |
11,009 |
$291K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,109 |
1,861 |
$240K |
| D1120 |
Prophylaxis - child |
7,903 |
7,378 |
$207K |
| D1110 |
Prophylaxis - adult |
5,264 |
4,989 |
$198K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,354 |
984 |
$173K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,879 |
2,538 |
$121K |
| D1206 |
Topical application of fluoride varnish |
7,561 |
7,043 |
$119K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,685 |
930 |
$104K |
| D1351 |
Sealant - per tooth |
3,370 |
934 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,953 |
1,828 |
$84K |
| D0272 |
Bitewings - two radiographic images |
3,778 |
3,538 |
$67K |
| D0330 |
Panoramic radiographic image |
1,229 |
1,136 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,927 |
1,828 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
1,412 |
1,295 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,630 |
2,504 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,807 |
2,562 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
299 |
280 |
$20K |
| D2332 |
|
144 |
86 |
$12K |
| D2331 |
|
107 |
81 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
636 |
349 |
$7K |
| D0240 |
|
297 |
160 |
$5K |
| D2335 |
|
35 |
25 |
$4K |
| D2394 |
|
23 |
16 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19 |
13 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
12 |
$2K |
| D2330 |
|
24 |
14 |
$2K |
| D4355 |
|
14 |
13 |
$829.52 |