| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,517 |
1,323 |
$234K |
| D1351 |
Sealant - per tooth |
9,510 |
1,802 |
$223K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,255 |
1,338 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
5,401 |
5,198 |
$139K |
| D1110 |
Prophylaxis - adult |
2,859 |
2,765 |
$137K |
| D1120 |
Prophylaxis - child |
3,224 |
3,111 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,286 |
6,078 |
$81K |
| D0145 |
Oral evaluation for a patient under three years of age |
666 |
653 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,968 |
2,865 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
1,652 |
1,543 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,674 |
1,593 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
4,441 |
4,273 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,305 |
4,043 |
$35K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
228 |
44 |
$31K |
| D0330 |
Panoramic radiographic image |
2,013 |
1,899 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,858 |
1,669 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,134 |
1,089 |
$22K |
| D0350 |
|
1,318 |
1,271 |
$13K |
| D7240 |
Removal of impacted tooth - completely bony |
38 |
14 |
$11K |
| D2330 |
|
187 |
95 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
82 |
43 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
232 |
115 |
$6K |
| D2331 |
|
26 |
14 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
13 |
$315.36 |
| D3120 |
|
55 |
25 |
$86.01 |
| D1330 |
|
27 |
26 |
$68.02 |
| D0603 |
|
6,232 |
5,980 |
$2.05 |
| D0602 |
|
1,310 |
1,269 |
$0.15 |
| D0601 |
|
582 |
565 |
$0.07 |