| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25,503 |
19,167 |
$1.68M |
| D0120 |
Periodic oral evaluation - established patient |
60,733 |
60,003 |
$1.52M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22,923 |
15,784 |
$1.22M |
| D1120 |
Prophylaxis - child |
50,624 |
49,801 |
$1.16M |
| D1208 |
Topical application of fluoride, excluding varnish |
55,013 |
54,211 |
$823K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
37,997 |
35,398 |
$803K |
| D1110 |
Prophylaxis - adult |
18,772 |
18,489 |
$706K |
| D1351 |
Sealant - per tooth |
38,689 |
12,773 |
$645K |
| D0330 |
Panoramic radiographic image |
15,071 |
14,726 |
$561K |
| D0220 |
Intraoral - periapical first radiographic image |
64,897 |
63,614 |
$517K |
| D1206 |
Topical application of fluoride varnish |
17,077 |
16,634 |
$426K |
| D9999 |
Unspecified adjunctive procedure, by report |
13,725 |
13,456 |
$394K |
| D0272 |
Bitewings - two radiographic images |
32,869 |
32,396 |
$321K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,382 |
7,946 |
$303K |
| D0191 |
|
22,393 |
21,889 |
$250K |
| D0274 |
Bitewings - four radiographic images |
25,497 |
25,015 |
$238K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,901 |
2,595 |
$204K |
| D0230 |
Intraoral - periapical each additional radiographic image |
68,938 |
60,364 |
$168K |
| D1999 |
|
8,947 |
8,315 |
$117K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,193 |
884 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
3,002 |
2,930 |
$62K |
| D1330 |
|
3,927 |
3,775 |
$46K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
176 |
37 |
$35K |
| D2330 |
|
229 |
173 |
$14K |
| D7240 |
Removal of impacted tooth - completely bony |
75 |
25 |
$14K |
| D2331 |
|
165 |
135 |
$11K |
| D9920 |
|
178 |
168 |
$5K |
| D9630 |
|
102 |
102 |
$5K |
| D2332 |
|
52 |
41 |
$4K |
| D7230 |
|
24 |
12 |
$4K |
| D7111 |
|
60 |
48 |
$2K |
| D0270 |
|
212 |
206 |
$1K |