| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,947 |
2,754 |
$659K |
| D1120 |
Prophylaxis - child |
13,992 |
13,513 |
$425K |
| D0330 |
Panoramic radiographic image |
6,411 |
6,186 |
$261K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,931 |
976 |
$261K |
| D0120 |
Periodic oral evaluation - established patient |
8,845 |
8,580 |
$244K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,805 |
1,381 |
$232K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,603 |
5,364 |
$226K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,594 |
994 |
$225K |
| D1206 |
Topical application of fluoride varnish |
8,654 |
8,386 |
$224K |
| D1351 |
Sealant - per tooth |
6,302 |
1,503 |
$179K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,462 |
758 |
$115K |
| D0210 |
Intraoral - complete series of radiographic images |
1,517 |
1,485 |
$103K |
| D0140 |
Limited oral evaluation - problem focused |
2,549 |
2,404 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,621 |
5,406 |
$93K |
| D0274 |
Bitewings - four radiographic images |
3,411 |
3,316 |
$88K |
| D0272 |
Bitewings - two radiographic images |
4,153 |
3,999 |
$70K |
| D2394 |
|
99 |
80 |
$18K |
| D2335 |
|
102 |
49 |
$15K |
| D1110 |
Prophylaxis - adult |
279 |
268 |
$13K |
| D2330 |
|
122 |
67 |
$8K |
| D2332 |
|
22 |
12 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
241 |
226 |
$3K |