| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,296 |
3,761 |
$449K |
| D1120 |
Prophylaxis - child |
13,122 |
12,645 |
$411K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,037 |
3,744 |
$366K |
| D0120 |
Periodic oral evaluation - established patient |
16,322 |
15,728 |
$359K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,889 |
16,256 |
$301K |
| D0272 |
Bitewings - two radiographic images |
10,539 |
10,074 |
$220K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,642 |
665 |
$176K |
| D1110 |
Prophylaxis - adult |
4,189 |
4,042 |
$174K |
| D0330 |
Panoramic radiographic image |
3,429 |
3,261 |
$148K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,767 |
3,233 |
$102K |
| D0274 |
Bitewings - four radiographic images |
2,642 |
2,527 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,878 |
1,784 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
662 |
358 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
708 |
664 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,259 |
1,167 |
$14K |
| D1351 |
Sealant - per tooth |
160 |
52 |
$4K |
| D1354 |
|
149 |
80 |
$2K |
| D0240 |
|
48 |
38 |
$844.77 |
| D0999 |
Unspecified diagnostic procedure, by report |
40 |
30 |
$301.15 |
| D0270 |
|
15 |
12 |
$195.17 |
| D3120 |
|
21 |
15 |
$0.00 |