| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,847 |
2,323 |
$335K |
| D1351 |
Sealant - per tooth |
10,246 |
1,849 |
$244K |
| D1120 |
Prophylaxis - child |
5,244 |
5,100 |
$220K |
| D1110 |
Prophylaxis - adult |
4,682 |
4,556 |
$217K |
| D0120 |
Periodic oral evaluation - established patient |
7,098 |
6,913 |
$191K |
| D1206 |
Topical application of fluoride varnish |
5,863 |
5,698 |
$151K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,648 |
926 |
$96K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
851 |
489 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,634 |
2,587 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
989 |
954 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,386 |
7,564 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
8,738 |
8,412 |
$44K |
| D0274 |
Bitewings - four radiographic images |
3,901 |
3,781 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,758 |
1,588 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,231 |
1,178 |
$29K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
152 |
74 |
$16K |
| D0272 |
Bitewings - two radiographic images |
2,379 |
2,314 |
$14K |
| D0603 |
|
1,559 |
1,498 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
405 |
387 |
$7K |
| D0601 |
|
486 |
479 |
$4K |
| D2332 |
|
47 |
28 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
17 |
$1K |
| D0602 |
|
154 |
140 |
$960.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
38 |
38 |
$658.75 |
| D0270 |
|
29 |
26 |
$124.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$80.00 |
| D9310 |
|
13 |
13 |
$20.00 |