| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,191 |
2,659 |
$512K |
| D1120 |
Prophylaxis - child |
9,139 |
8,977 |
$400K |
| D1206 |
Topical application of fluoride varnish |
15,909 |
15,641 |
$396K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,106 |
1,986 |
$288K |
| D0120 |
Periodic oral evaluation - established patient |
9,707 |
9,529 |
$287K |
| D1351 |
Sealant - per tooth |
8,491 |
2,187 |
$286K |
| D1110 |
Prophylaxis - adult |
3,296 |
3,242 |
$202K |
| D0330 |
Panoramic radiographic image |
2,717 |
2,671 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,162 |
2,130 |
$117K |
| D0274 |
Bitewings - four radiographic images |
3,612 |
3,557 |
$82K |
| D0140 |
Limited oral evaluation - problem focused |
1,305 |
1,271 |
$59K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
335 |
205 |
$54K |
| D0272 |
Bitewings - two radiographic images |
3,250 |
3,174 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,662 |
2,406 |
$49K |
| D1330 |
|
7,678 |
7,536 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
299 |
230 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
181 |
130 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,505 |
1,465 |
$15K |
| D3120 |
|
230 |
161 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
119 |
119 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
56 |
56 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30 |
30 |
$436.08 |