| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,710 |
2,383 |
$341K |
| D1120 |
Prophylaxis - child |
12,271 |
12,157 |
$338K |
| D1206 |
Topical application of fluoride varnish |
13,155 |
13,032 |
$222K |
| D0120 |
Periodic oral evaluation - established patient |
11,888 |
11,783 |
$194K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,145 |
519 |
$173K |
| D9630 |
|
10,407 |
10,302 |
$171K |
| D9920 |
|
1,350 |
1,311 |
$85K |
| D0272 |
Bitewings - two radiographic images |
4,714 |
4,666 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,437 |
690 |
$76K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,155 |
1,886 |
$57K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
807 |
117 |
$52K |
| D1110 |
Prophylaxis - adult |
1,148 |
1,136 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,253 |
1,235 |
$33K |
| D1351 |
Sealant - per tooth |
1,716 |
600 |
$31K |
| D9310 |
|
374 |
369 |
$27K |
| D3120 |
|
1,365 |
587 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
242 |
150 |
$16K |
| D0330 |
Panoramic radiographic image |
267 |
267 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
305 |
300 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
152 |
99 |
$10K |
| D0274 |
Bitewings - four radiographic images |
336 |
331 |
$7K |
| D9222 |
|
104 |
104 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
738 |
716 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
573 |
200 |
$5K |
| D0240 |
|
409 |
236 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
126 |
123 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
107 |
107 |
$2K |