| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,869 |
2,310 |
$390K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,349 |
2,592 |
$389K |
| D1110 |
Prophylaxis - adult |
6,597 |
6,071 |
$302K |
| D0120 |
Periodic oral evaluation - established patient |
6,717 |
6,424 |
$182K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,991 |
3,647 |
$178K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,165 |
3,644 |
$161K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,224 |
833 |
$155K |
| D0272 |
Bitewings - two radiographic images |
7,404 |
6,942 |
$152K |
| D1120 |
Prophylaxis - child |
4,189 |
4,160 |
$152K |
| D0330 |
Panoramic radiographic image |
2,737 |
2,717 |
$150K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
786 |
395 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,791 |
3,752 |
$78K |
| D1351 |
Sealant - per tooth |
1,956 |
624 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
4,960 |
4,261 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
2,882 |
2,839 |
$50K |
| D1206 |
Topical application of fluoride varnish |
1,728 |
1,718 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
503 |
370 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,472 |
1,887 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
110 |
86 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
120 |
120 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
81 |
78 |
$4K |
| D9986 |
|
227 |
217 |
$0.00 |