| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,410 |
1,902 |
$379K |
| D0120 |
Periodic oral evaluation - established patient |
9,662 |
9,283 |
$352K |
| D1206 |
Topical application of fluoride varnish |
10,483 |
10,056 |
$306K |
| D1120 |
Prophylaxis - child |
8,451 |
8,111 |
$268K |
| D1351 |
Sealant - per tooth |
8,631 |
2,621 |
$210K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,711 |
1,466 |
$191K |
| D1110 |
Prophylaxis - adult |
3,062 |
2,933 |
$146K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,076 |
387 |
$131K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,601 |
821 |
$103K |
| D0330 |
Panoramic radiographic image |
1,804 |
1,751 |
$94K |
| D0272 |
Bitewings - two radiographic images |
6,214 |
5,953 |
$93K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,074 |
1,902 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,368 |
2,261 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,079 |
1,028 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,171 |
1,108 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,334 |
2,226 |
$37K |
| D9248 |
|
371 |
350 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,149 |
973 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
158 |
155 |
$6K |
| D1330 |
|
904 |
850 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
26 |
$4K |
| D1310 |
|
156 |
154 |
$2K |
| D9440 |
|
21 |
20 |
$2K |
| D2330 |
|
17 |
12 |
$1K |