| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,139 |
2,156 |
$432K |
| D0120 |
Periodic oral evaluation - established patient |
11,893 |
11,402 |
$301K |
| D1120 |
Prophylaxis - child |
10,941 |
10,502 |
$287K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,510 |
4,022 |
$196K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,458 |
1,517 |
$191K |
| D1351 |
Sealant - per tooth |
5,703 |
1,404 |
$149K |
| D1206 |
Topical application of fluoride varnish |
9,242 |
8,911 |
$143K |
| D1110 |
Prophylaxis - adult |
3,860 |
3,690 |
$142K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
882 |
287 |
$129K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,551 |
5,256 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,911 |
1,824 |
$82K |
| D0272 |
Bitewings - two radiographic images |
4,089 |
3,942 |
$72K |
| D0330 |
Panoramic radiographic image |
1,299 |
1,248 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
900 |
491 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,915 |
2,278 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
3,735 |
3,520 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,634 |
1,561 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,057 |
1,005 |
$39K |
| D0145 |
Oral evaluation for a patient under three years of age |
578 |
551 |
$19K |
| D0240 |
|
822 |
405 |
$13K |
| D9420 |
|
101 |
88 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
13 |
$2K |
| D1354 |
|
32 |
12 |
$242.00 |