| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,661 |
1,596 |
$325K |
| D1351 |
Sealant - per tooth |
6,363 |
1,363 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
4,748 |
4,638 |
$99K |
| D1110 |
Prophylaxis - adult |
2,100 |
2,053 |
$79K |
| D1120 |
Prophylaxis - child |
3,118 |
3,043 |
$79K |
| D0145 |
Oral evaluation for a patient under three years of age |
769 |
754 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,161 |
525 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,780 |
5,461 |
$57K |
| D1206 |
Topical application of fluoride varnish |
5,221 |
5,094 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,220 |
2,143 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
5,757 |
5,508 |
$47K |
| D0272 |
Bitewings - two radiographic images |
2,579 |
2,477 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
900 |
873 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,181 |
1,106 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
112 |
27 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
105 |
105 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
55 |
28 |
$5K |
| D0330 |
Panoramic radiographic image |
311 |
294 |
$3K |
| D2330 |
|
38 |
24 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
107 |
106 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$694.80 |
| D0603 |
|
6,459 |
6,294 |
$2.30 |
| D0601 |
|
75 |
75 |
$0.09 |
| D0602 |
|
40 |
39 |
$0.00 |