| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,102 |
1,379 |
$483K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,651 |
804 |
$197K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
971 |
509 |
$188K |
| D1120 |
Prophylaxis - child |
3,961 |
3,917 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
4,529 |
4,481 |
$156K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
483 |
206 |
$143K |
| D0272 |
Bitewings - two radiographic images |
2,475 |
2,450 |
$97K |
| D1110 |
Prophylaxis - adult |
1,263 |
1,242 |
$95K |
| D0274 |
Bitewings - four radiographic images |
1,889 |
1,861 |
$88K |
| D1206 |
Topical application of fluoride varnish |
2,774 |
2,753 |
$79K |
| D0330 |
Panoramic radiographic image |
867 |
847 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
795 |
780 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,407 |
2,374 |
$59K |
| D1351 |
Sealant - per tooth |
1,475 |
544 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,178 |
1,098 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
1,912 |
1,870 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,398 |
1,376 |
$22K |
| D2394 |
|
50 |
27 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
227 |
225 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
19 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
695 |
661 |
$0.00 |
| D8660 |
|
19 |
13 |
$0.00 |