| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,492 |
2,784 |
$624K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,567 |
1,698 |
$464K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,468 |
780 |
$401K |
| D1120 |
Prophylaxis - child |
9,358 |
9,252 |
$274K |
| D2390 |
|
1,272 |
368 |
$258K |
| D0120 |
Periodic oral evaluation - established patient |
12,316 |
12,174 |
$251K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,968 |
1,513 |
$229K |
| D1110 |
Prophylaxis - adult |
4,370 |
4,315 |
$190K |
| D1206 |
Topical application of fluoride varnish |
12,329 |
12,185 |
$189K |
| D2332 |
|
1,537 |
686 |
$158K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,661 |
4,302 |
$119K |
| D0240 |
|
6,552 |
3,655 |
$117K |
| D0330 |
Panoramic radiographic image |
1,976 |
1,952 |
$92K |
| D0274 |
Bitewings - four radiographic images |
2,782 |
2,738 |
$81K |
| D0272 |
Bitewings - two radiographic images |
4,122 |
4,097 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
3,996 |
3,820 |
$58K |
| D3120 |
|
1,759 |
637 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,389 |
2,431 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,213 |
1,171 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
386 |
177 |
$24K |
| D1351 |
Sealant - per tooth |
844 |
244 |
$19K |
| D2330 |
|
314 |
162 |
$18K |
| D2331 |
|
149 |
90 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
363 |
359 |
$10K |
| D2394 |
|
43 |
26 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
52 |
25 |
$6K |