| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,742 |
5,287 |
$888K |
| D1351 |
Sealant - per tooth |
27,890 |
6,701 |
$752K |
| D0120 |
Periodic oral evaluation - established patient |
29,412 |
28,657 |
$748K |
| D1120 |
Prophylaxis - child |
24,148 |
23,381 |
$642K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,161 |
1,867 |
$565K |
| D1208 |
Topical application of fluoride, excluding varnish |
33,361 |
32,227 |
$540K |
| D1110 |
Prophylaxis - adult |
9,028 |
8,703 |
$329K |
| D0330 |
Panoramic radiographic image |
4,652 |
4,390 |
$240K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,264 |
4,862 |
$216K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,847 |
4,414 |
$208K |
| D0272 |
Bitewings - two radiographic images |
11,779 |
11,311 |
$207K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,152 |
1,416 |
$158K |
| D0274 |
Bitewings - four radiographic images |
4,761 |
4,579 |
$145K |
| D0140 |
Limited oral evaluation - problem focused |
4,038 |
3,684 |
$143K |
| D2332 |
|
1,372 |
806 |
$128K |
| D0220 |
Intraoral - periapical first radiographic image |
8,058 |
7,395 |
$115K |
| D2330 |
|
1,814 |
973 |
$111K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,263 |
820 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
484 |
374 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,056 |
2,477 |
$42K |
| D2331 |
|
263 |
154 |
$19K |
| D0240 |
|
772 |
703 |
$12K |
| D7111 |
|
223 |
157 |
$11K |
| D0170 |
|
266 |
260 |
$8K |
| D9420 |
|
43 |
40 |
$4K |
| D2335 |
|
21 |
12 |
$2K |
| D1354 |
|
30 |
13 |
$230.09 |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
17 |
$0.00 |