| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,328 |
668 |
$209K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,418 |
702 |
$174K |
| D2332 |
|
1,393 |
333 |
$165K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
816 |
233 |
$128K |
| D2330 |
|
1,420 |
369 |
$93K |
| D1351 |
Sealant - per tooth |
3,746 |
707 |
$82K |
| D9630 |
|
2,015 |
1,912 |
$82K |
| D1206 |
Topical application of fluoride varnish |
3,307 |
3,109 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,756 |
1,589 |
$64K |
| D1120 |
Prophylaxis - child |
2,639 |
2,482 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,849 |
1,801 |
$56K |
| D1110 |
Prophylaxis - adult |
740 |
713 |
$31K |
| D0330 |
Panoramic radiographic image |
860 |
785 |
$28K |
| D9999 |
Unspecified adjunctive procedure, by report |
693 |
667 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
763 |
659 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,989 |
1,761 |
$14K |
| D0274 |
Bitewings - four radiographic images |
625 |
580 |
$8K |
| D0272 |
Bitewings - two radiographic images |
881 |
815 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,626 |
1,600 |
$7K |
| D1354 |
|
1,022 |
151 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
29 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
88 |
73 |
$2K |