| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,358 |
759 |
$176K |
| D1120 |
Prophylaxis - child |
3,775 |
3,630 |
$131K |
| D0120 |
Periodic oral evaluation - established patient |
4,932 |
4,709 |
$119K |
| D1206 |
Topical application of fluoride varnish |
5,536 |
5,262 |
$117K |
| D1110 |
Prophylaxis - adult |
1,939 |
1,832 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
4,079 |
3,481 |
$69K |
| D0272 |
Bitewings - two radiographic images |
3,107 |
2,954 |
$65K |
| D1351 |
Sealant - per tooth |
1,785 |
498 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,400 |
1,332 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
652 |
425 |
$45K |
| D9920 |
|
321 |
285 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,381 |
1,228 |
$41K |
| D9243 |
|
156 |
136 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,480 |
2,844 |
$34K |
| D0330 |
Panoramic radiographic image |
595 |
570 |
$33K |
| D1310 |
|
743 |
718 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
123 |
62 |
$18K |
| D0603 |
|
1,805 |
1,738 |
$18K |
| D1330 |
|
738 |
714 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
244 |
118 |
$16K |
| D9248 |
|
111 |
97 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
309 |
294 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
279 |
266 |
$10K |
| D9630 |
|
412 |
368 |
$6K |
| D0602 |
|
636 |
581 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
112 |
111 |
$4K |
| D4212 |
|
30 |
22 |
$3K |
| D0601 |
|
187 |
185 |
$2K |
| D4355 |
|
20 |
20 |
$1K |
| D0425 |
|
24 |
24 |
$1K |