| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,664 |
5,851 |
$1.02M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,682 |
5,239 |
$780K |
| D0120 |
Periodic oral evaluation - established patient |
24,288 |
23,855 |
$627K |
| D1120 |
Prophylaxis - child |
21,663 |
21,377 |
$586K |
| D1351 |
Sealant - per tooth |
15,644 |
4,227 |
$428K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,620 |
18,245 |
$307K |
| D0330 |
Panoramic radiographic image |
4,235 |
4,156 |
$240K |
| D0220 |
Intraoral - periapical first radiographic image |
14,937 |
14,477 |
$222K |
| D1110 |
Prophylaxis - adult |
5,923 |
5,818 |
$221K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,516 |
1,167 |
$194K |
| D0272 |
Bitewings - two radiographic images |
9,204 |
9,058 |
$166K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,050 |
11,622 |
$156K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,541 |
3,479 |
$152K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,561 |
3,337 |
$151K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,036 |
1,392 |
$126K |
| D1206 |
Topical application of fluoride varnish |
7,180 |
7,098 |
$116K |
| D0274 |
Bitewings - four radiographic images |
3,411 |
3,318 |
$107K |
| D0140 |
Limited oral evaluation - problem focused |
2,278 |
2,194 |
$82K |
| D0240 |
|
2,048 |
1,988 |
$46K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
261 |
200 |
$37K |
| D2330 |
|
165 |
113 |
$11K |
| D4355 |
|
167 |
165 |
$11K |
| D7111 |
|
96 |
68 |
$5K |
| D2940 |
|
22 |
15 |
$909.76 |