| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,267 |
2,145 |
$268K |
| D0120 |
Periodic oral evaluation - established patient |
8,956 |
8,871 |
$210K |
| D1110 |
Prophylaxis - adult |
5,022 |
4,962 |
$209K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,454 |
9,354 |
$192K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,811 |
5,290 |
$169K |
| D1120 |
Prophylaxis - child |
4,838 |
4,798 |
$159K |
| D2394 |
|
1,606 |
1,084 |
$139K |
| D1354 |
|
14,987 |
2,227 |
$117K |
| D0274 |
Bitewings - four radiographic images |
3,396 |
3,347 |
$88K |
| D0330 |
Panoramic radiographic image |
1,765 |
1,753 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,047 |
716 |
$75K |
| D1351 |
Sealant - per tooth |
1,946 |
795 |
$57K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
444 |
273 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,603 |
3,496 |
$43K |
| D0272 |
Bitewings - two radiographic images |
2,418 |
2,391 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
619 |
347 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,083 |
1,672 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
588 |
584 |
$16K |
| D2950 |
|
132 |
108 |
$16K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
22 |
16 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
136 |
84 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
364 |
355 |
$7K |
| D2335 |
|
58 |
37 |
$5K |
| D9986 |
|
29 |
29 |
$0.00 |
| D0350 |
|
17 |
12 |
$0.00 |