| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,679 |
1,348 |
$293K |
| D0120 |
Periodic oral evaluation - established patient |
4,889 |
4,773 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,543 |
2,425 |
$111K |
| D1120 |
Prophylaxis - child |
3,933 |
3,855 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,974 |
4,060 |
$105K |
| D1110 |
Prophylaxis - adult |
2,558 |
2,484 |
$96K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,945 |
1,664 |
$90K |
| D1351 |
Sealant - per tooth |
2,920 |
845 |
$82K |
| D1206 |
Topical application of fluoride varnish |
4,582 |
4,478 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
5,061 |
4,758 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
888 |
467 |
$72K |
| D0274 |
Bitewings - four radiographic images |
1,758 |
1,683 |
$52K |
| D0330 |
Panoramic radiographic image |
997 |
954 |
$51K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
296 |
108 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
715 |
697 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,195 |
1,177 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
285 |
168 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
79 |
55 |
$10K |
| D0240 |
|
586 |
286 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
560 |
531 |
$9K |
| D9420 |
|
58 |
57 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
50 |
15 |
$6K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
58 |
31 |
$4K |
| D9222 |
|
31 |
31 |
$2K |
| D9612 |
|
31 |
31 |
$2K |
| D4355 |
|
27 |
25 |
$2K |
| D0160 |
|
17 |
16 |
$1K |