| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,983 |
5,161 |
$568K |
| D0120 |
Periodic oral evaluation - established patient |
21,178 |
19,238 |
$421K |
| D1120 |
Prophylaxis - child |
13,812 |
12,588 |
$405K |
| D1110 |
Prophylaxis - adult |
9,243 |
8,422 |
$380K |
| D1351 |
Sealant - per tooth |
17,163 |
3,250 |
$372K |
| D1206 |
Topical application of fluoride varnish |
17,290 |
15,716 |
$324K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,266 |
3,541 |
$297K |
| D1354 |
|
4,699 |
964 |
$269K |
| D0210 |
Intraoral - complete series of radiographic images |
4,500 |
3,879 |
$177K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,953 |
1,395 |
$147K |
| D0274 |
Bitewings - four radiographic images |
5,479 |
4,935 |
$147K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,567 |
4,626 |
$147K |
| D0272 |
Bitewings - two radiographic images |
7,547 |
6,804 |
$140K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,366 |
3,979 |
$130K |
| D4346 |
|
874 |
784 |
$123K |
| D0330 |
Panoramic radiographic image |
4,164 |
3,705 |
$111K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,433 |
963 |
$101K |
| D0140 |
Limited oral evaluation - problem focused |
3,356 |
3,004 |
$95K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
540 |
363 |
$77K |
| D2332 |
|
643 |
380 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
4,561 |
3,732 |
$40K |
| D2335 |
|
280 |
173 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,732 |
2,470 |
$26K |
| D0240 |
|
1,358 |
693 |
$17K |
| D2330 |
|
236 |
151 |
$17K |
| D2331 |
|
140 |
82 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
283 |
266 |
$9K |
| D4910 |
|
83 |
70 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
928 |
488 |
$7K |
| D2394 |
|
57 |
41 |
$6K |
| D0277 |
|
104 |
92 |
$3K |
| D7111 |
|
26 |
13 |
$2K |
| D1510 |
|
13 |
12 |
$2K |
| D9920 |
|
42 |
36 |
$1K |
| D0270 |
|
59 |
55 |
$990.20 |
| D1352 |
|
22 |
12 |
$709.00 |
| D1999 |
|
9,342 |
6,822 |
$30.00 |
| D1330 |
|
1,603 |
1,549 |
$0.00 |