| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,556 |
2,821 |
$603K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,537 |
760 |
$360K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,350 |
2,475 |
$356K |
| D1120 |
Prophylaxis - child |
9,902 |
9,677 |
$273K |
| D0120 |
Periodic oral evaluation - established patient |
9,329 |
9,191 |
$246K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,794 |
4,607 |
$228K |
| D1206 |
Topical application of fluoride varnish |
11,500 |
11,239 |
$184K |
| D1351 |
Sealant - per tooth |
5,534 |
1,853 |
$150K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,442 |
5,811 |
$117K |
| D0220 |
Intraoral - periapical first radiographic image |
7,000 |
6,774 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,173 |
2,075 |
$96K |
| D0272 |
Bitewings - two radiographic images |
4,700 |
4,554 |
$83K |
| D2390 |
|
493 |
182 |
$83K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,281 |
660 |
$81K |
| D0330 |
Panoramic radiographic image |
1,176 |
1,149 |
$60K |
| D1110 |
Prophylaxis - adult |
1,507 |
1,486 |
$58K |
| D9420 |
|
298 |
266 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
757 |
745 |
$29K |
| D0274 |
Bitewings - four radiographic images |
559 |
544 |
$17K |
| D1354 |
|
1,098 |
482 |
$8K |
| D2330 |
|
22 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$456.12 |