| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,914 |
5,249 |
$551K |
| D1120 |
Prophylaxis - child |
18,159 |
17,405 |
$535K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,061 |
4,038 |
$322K |
| D0120 |
Periodic oral evaluation - established patient |
16,839 |
16,266 |
$320K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,276 |
7,858 |
$264K |
| D1110 |
Prophylaxis - adult |
7,150 |
6,835 |
$231K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,073 |
12,451 |
$208K |
| D0274 |
Bitewings - four radiographic images |
9,053 |
8,727 |
$183K |
| D0272 |
Bitewings - two radiographic images |
10,424 |
10,013 |
$158K |
| D1206 |
Topical application of fluoride varnish |
11,633 |
11,252 |
$136K |
| D1351 |
Sealant - per tooth |
8,135 |
2,739 |
$125K |
| D0220 |
Intraoral - periapical first radiographic image |
10,450 |
9,888 |
$96K |
| D0330 |
Panoramic radiographic image |
7,033 |
6,654 |
$92K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,148 |
617 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
1,390 |
1,374 |
$77K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,939 |
4,234 |
$73K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,354 |
1,289 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,254 |
6,387 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
1,669 |
1,559 |
$40K |
| D7240 |
Removal of impacted tooth - completely bony |
124 |
41 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
256 |
153 |
$13K |
| D2394 |
|
475 |
219 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
14 |
$2K |
| D0270 |
|
70 |
68 |
$353.07 |
| D1999 |
|
2,000 |
1,678 |
$167.20 |