| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
6,375 |
2,450 |
$536K |
| D1120 |
Prophylaxis - child |
10,120 |
9,599 |
$262K |
| D0120 |
Periodic oral evaluation - established patient |
10,998 |
10,446 |
$192K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,442 |
12,737 |
$181K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,939 |
519 |
$161K |
| D1999 |
|
7,936 |
7,217 |
$146K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,514 |
1,354 |
$121K |
| D0330 |
Panoramic radiographic image |
2,255 |
2,112 |
$97K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,582 |
4,148 |
$90K |
| D0272 |
Bitewings - two radiographic images |
5,388 |
5,116 |
$88K |
| D0240 |
|
4,003 |
1,904 |
$64K |
| D1110 |
Prophylaxis - adult |
1,969 |
1,842 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,983 |
1,838 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
635 |
421 |
$46K |
| D1351 |
Sealant - per tooth |
2,492 |
697 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,871 |
1,730 |
$41K |
| D1354 |
|
945 |
270 |
$26K |
| D0274 |
Bitewings - four radiographic images |
877 |
820 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,497 |
1,401 |
$14K |
| D1206 |
Topical application of fluoride varnish |
332 |
303 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
627 |
501 |
$6K |
| D2335 |
|
42 |
24 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
100 |
98 |
$2K |