| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,007 |
5,083 |
$1.36M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,065 |
2,912 |
$528K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,052 |
2,019 |
$495K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,053 |
2,272 |
$494K |
| D0120 |
Periodic oral evaluation - established patient |
15,821 |
15,698 |
$375K |
| D1110 |
Prophylaxis - adult |
7,094 |
7,018 |
$321K |
| D1120 |
Prophylaxis - child |
9,543 |
9,507 |
$320K |
| D4342 |
|
2,997 |
1,121 |
$272K |
| D4910 |
|
3,533 |
3,445 |
$238K |
| D0274 |
Bitewings - four radiographic images |
7,999 |
7,906 |
$236K |
| D1206 |
Topical application of fluoride varnish |
12,082 |
11,971 |
$234K |
| D0330 |
Panoramic radiographic image |
3,662 |
3,632 |
$187K |
| D1351 |
Sealant - per tooth |
3,875 |
1,185 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,309 |
3,276 |
$132K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,022 |
440 |
$130K |
| D0180 |
|
2,807 |
2,779 |
$119K |
| D0140 |
Limited oral evaluation - problem focused |
3,212 |
3,133 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
7,567 |
7,387 |
$94K |
| D2330 |
|
964 |
568 |
$93K |
| D4346 |
|
1,970 |
1,907 |
$88K |
| D0272 |
Bitewings - two radiographic images |
3,986 |
3,962 |
$84K |
| D2331 |
|
633 |
421 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,501 |
3,446 |
$60K |
| D2394 |
|
301 |
235 |
$57K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,207 |
1,200 |
$38K |
| D2332 |
|
233 |
148 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,035 |
987 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
1,111 |
1,086 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,437 |
2,410 |
$28K |
| D2335 |
|
135 |
90 |
$22K |
| D3120 |
|
443 |
280 |
$17K |
| D0240 |
|
277 |
277 |
$11K |
| D2931 |
|
52 |
41 |
$7K |
| D9248 |
|
42 |
40 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
13 |
$2K |
| D4355 |
|
30 |
30 |
$2K |
| D9310 |
|
12 |
12 |
$478.80 |