| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,718 |
2,148 |
$255K |
| D1120 |
Prophylaxis - child |
6,131 |
6,072 |
$168K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,852 |
1,684 |
$168K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,866 |
7,771 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
7,877 |
7,784 |
$124K |
| D1110 |
Prophylaxis - adult |
3,355 |
3,293 |
$116K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,085 |
2,723 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
989 |
592 |
$62K |
| D1351 |
Sealant - per tooth |
2,375 |
961 |
$62K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
498 |
255 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,852 |
1,767 |
$46K |
| D0272 |
Bitewings - two radiographic images |
2,248 |
2,226 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,725 |
1,690 |
$35K |
| D9994 |
|
6,953 |
6,413 |
$34K |
| D9920 |
|
719 |
658 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
1,798 |
1,668 |
$28K |
| D0330 |
Panoramic radiographic image |
627 |
597 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,781 |
2,585 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
979 |
827 |
$23K |
| D8670 |
Periodic orthodontic treatment visit |
41 |
41 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,157 |
652 |
$9K |
| D3120 |
|
665 |
403 |
$8K |
| D0340 |
|
160 |
160 |
$6K |
| D0240 |
|
394 |
236 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
58 |
48 |
$3K |
| D1206 |
Topical application of fluoride varnish |
255 |
253 |
$2K |
| D9630 |
|
258 |
249 |
$2K |
| D8660 |
|
27 |
27 |
$2K |
| D1354 |
|
39 |
14 |
$0.00 |
| D1999 |
|
16 |
13 |
$0.00 |