| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,995 |
2,633 |
$558K |
| D8670 |
Periodic orthodontic treatment visit |
2,254 |
2,155 |
$543K |
| D1120 |
Prophylaxis - child |
7,035 |
6,865 |
$362K |
| D1206 |
Topical application of fluoride varnish |
9,011 |
8,767 |
$234K |
| D0120 |
Periodic oral evaluation - established patient |
6,726 |
6,550 |
$199K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,966 |
1,908 |
$114K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
548 |
240 |
$106K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,028 |
560 |
$102K |
| D1110 |
Prophylaxis - adult |
1,345 |
1,305 |
$94K |
| D0272 |
Bitewings - two radiographic images |
2,746 |
2,646 |
$82K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
879 |
582 |
$74K |
| D1351 |
Sealant - per tooth |
1,558 |
516 |
$64K |
| D0274 |
Bitewings - four radiographic images |
1,388 |
1,352 |
$60K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
510 |
265 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
353 |
259 |
$42K |
| D2335 |
|
177 |
101 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,386 |
1,244 |
$28K |
| D9310 |
|
412 |
362 |
$21K |
| D0330 |
Panoramic radiographic image |
291 |
279 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
791 |
753 |
$15K |
| D9110 |
|
166 |
162 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
149 |
144 |
$7K |
| D8660 |
|
129 |
126 |
$6K |
| D8690 |
|
12 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
108 |
30 |
$924.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
25 |
25 |
$775.00 |