| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,498 |
2,476 |
$392K |
| D2332 |
|
1,652 |
1,136 |
$200K |
| D1351 |
Sealant - per tooth |
8,318 |
2,256 |
$189K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,443 |
1,260 |
$174K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,284 |
4,807 |
$136K |
| D1120 |
Prophylaxis - child |
3,896 |
3,722 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
4,110 |
3,984 |
$112K |
| D0274 |
Bitewings - four radiographic images |
2,979 |
2,862 |
$92K |
| D1110 |
Prophylaxis - adult |
1,947 |
1,854 |
$92K |
| D0272 |
Bitewings - two radiographic images |
2,693 |
2,598 |
$59K |
| D1206 |
Topical application of fluoride varnish |
3,863 |
3,696 |
$53K |
| D0330 |
Panoramic radiographic image |
1,422 |
1,312 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,583 |
1,446 |
$47K |
| D0145 |
Oral evaluation for a patient under three years of age |
353 |
332 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
273 |
196 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,685 |
1,614 |
$23K |
| D2330 |
|
278 |
192 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
61 |
29 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
46 |
$4K |
| D2331 |
|
33 |
20 |
$3K |
| D9944 |
|
17 |
16 |
$2K |
| D0603 |
|
6,534 |
6,350 |
$9.02 |