| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,897 |
4,583 |
$804K |
| D0120 |
Periodic oral evaluation - established patient |
16,295 |
15,581 |
$407K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,736 |
2,982 |
$354K |
| D1110 |
Prophylaxis - adult |
8,559 |
8,214 |
$314K |
| D1120 |
Prophylaxis - child |
7,433 |
7,161 |
$197K |
| D0220 |
Intraoral - periapical first radiographic image |
13,581 |
12,920 |
$196K |
| D0274 |
Bitewings - four radiographic images |
6,436 |
6,135 |
$193K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,203 |
8,907 |
$150K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,245 |
11,141 |
$145K |
| D0330 |
Panoramic radiographic image |
2,408 |
2,286 |
$123K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
745 |
531 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,172 |
2,061 |
$88K |
| D1206 |
Topical application of fluoride varnish |
5,132 |
4,867 |
$80K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
640 |
175 |
$62K |
| D0272 |
Bitewings - two radiographic images |
3,391 |
3,293 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,464 |
1,383 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
801 |
295 |
$42K |
| D1351 |
Sealant - per tooth |
1,243 |
448 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
593 |
507 |
$25K |
| D4346 |
|
128 |
124 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15 |
12 |
$2K |
| D4342 |
|
29 |
12 |
$1K |