| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,584 |
1,675 |
$566K |
| D0120 |
Periodic oral evaluation - established patient |
12,571 |
12,146 |
$521K |
| D1120 |
Prophylaxis - child |
9,104 |
8,763 |
$494K |
| D1206 |
Topical application of fluoride varnish |
13,535 |
13,037 |
$442K |
| D1110 |
Prophylaxis - adult |
4,587 |
4,429 |
$334K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,124 |
846 |
$190K |
| D1351 |
Sealant - per tooth |
4,404 |
1,478 |
$190K |
| D0274 |
Bitewings - four radiographic images |
3,282 |
3,179 |
$172K |
| D0272 |
Bitewings - two radiographic images |
4,029 |
3,890 |
$147K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,991 |
1,793 |
$141K |
| D0330 |
Panoramic radiographic image |
1,403 |
1,366 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
2,139 |
2,028 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
309 |
189 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,881 |
856 |
$39K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
79 |
65 |
$20K |
| D1354 |
|
571 |
165 |
$17K |
| D0240 |
|
457 |
418 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
208 |
201 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
24 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
54 |
$4K |
| D9110 |
|
24 |
24 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
35 |
31 |
$2K |
| D9920 |
|
16 |
16 |
$1K |
| D0170 |
|
13 |
12 |
$798.20 |
| D1999 |
|
12 |
12 |
$0.00 |
| D0603 |
|
13,686 |
13,198 |
$0.00 |