| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,342 |
2,710 |
$447K |
| D1120 |
Prophylaxis - child |
16,080 |
15,202 |
$428K |
| D0120 |
Periodic oral evaluation - established patient |
14,806 |
14,037 |
$376K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,321 |
7,307 |
$363K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,748 |
17,708 |
$304K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,303 |
1,582 |
$181K |
| D1351 |
Sealant - per tooth |
6,090 |
1,616 |
$164K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,437 |
3,214 |
$148K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,690 |
1,027 |
$103K |
| D0272 |
Bitewings - two radiographic images |
4,853 |
4,626 |
$88K |
| D1110 |
Prophylaxis - adult |
2,299 |
2,204 |
$87K |
| D0220 |
Intraoral - periapical first radiographic image |
5,584 |
5,078 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
1,920 |
1,789 |
$69K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
494 |
307 |
$65K |
| D0240 |
|
3,846 |
1,861 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,911 |
1,614 |
$46K |
| D0330 |
Panoramic radiographic image |
530 |
519 |
$32K |
| D0274 |
Bitewings - four radiographic images |
802 |
755 |
$25K |
| D0170 |
|
342 |
313 |
$9K |
| D1206 |
Topical application of fluoride varnish |
268 |
245 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
106 |
81 |
$2K |
| D9420 |
|
22 |
16 |
$2K |
| D1354 |
|
218 |
64 |
$1K |
| D1330 |
|
1,225 |
1,223 |
$0.00 |
| D1310 |
|
1,069 |
1,067 |
$0.00 |
| D9630 |
|
125 |
119 |
$0.00 |