| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,241 |
1,135 |
$175K |
| D1206 |
Topical application of fluoride varnish |
7,702 |
7,394 |
$170K |
| D1120 |
Prophylaxis - child |
6,977 |
6,702 |
$162K |
| D0120 |
Periodic oral evaluation - established patient |
5,487 |
5,272 |
$159K |
| D1351 |
Sealant - per tooth |
5,567 |
1,405 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,558 |
2,454 |
$102K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
380 |
143 |
$67K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,430 |
2,318 |
$63K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,167 |
1,905 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
548 |
349 |
$35K |
| D0330 |
Panoramic radiographic image |
1,029 |
1,010 |
$34K |
| D0272 |
Bitewings - two radiographic images |
3,503 |
3,369 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
545 |
270 |
$30K |
| D9630 |
|
768 |
723 |
$29K |
| D1110 |
Prophylaxis - adult |
708 |
683 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,949 |
2,800 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
451 |
421 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,614 |
2,123 |
$6K |
| D1999 |
|
391 |
317 |
$4K |
| D0274 |
Bitewings - four radiographic images |
120 |
116 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
14 |
$2K |
| D0270 |
|
38 |
38 |
$253.44 |
| D1354 |
|
27 |
12 |
$75.00 |
| D0603 |
|
970 |
962 |
$0.00 |