| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,054 |
1,910 |
$283K |
| D1206 |
Topical application of fluoride varnish |
10,988 |
10,726 |
$268K |
| D0120 |
Periodic oral evaluation - established patient |
9,723 |
9,622 |
$264K |
| D1110 |
Prophylaxis - adult |
4,357 |
4,311 |
$195K |
| D1120 |
Prophylaxis - child |
5,666 |
5,616 |
$191K |
| D1351 |
Sealant - per tooth |
5,094 |
1,169 |
$160K |
| D0274 |
Bitewings - four radiographic images |
3,627 |
3,584 |
$101K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
915 |
695 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,239 |
1,218 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
770 |
280 |
$38K |
| D4910 |
|
403 |
400 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
324 |
323 |
$25K |
| D0330 |
Panoramic radiographic image |
856 |
844 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,220 |
2,099 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,155 |
1,143 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
263 |
246 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
129 |
98 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,346 |
545 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
255 |
253 |
$6K |
| D1999 |
|
516 |
500 |
$5K |
| D2740 |
Crown - porcelain/ceramic |
18 |
13 |
$5K |
| D2331 |
|
14 |
12 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
12 |
$1K |