| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,927 |
1,430 |
$521K |
| D1120 |
Prophylaxis - child |
7,201 |
7,135 |
$266K |
| D1206 |
Topical application of fluoride varnish |
9,764 |
9,664 |
$207K |
| D0120 |
Periodic oral evaluation - established patient |
7,470 |
7,417 |
$192K |
| D1110 |
Prophylaxis - adult |
1,995 |
1,967 |
$104K |
| D7140 |
Extraction, erupted tooth or exposed root |
872 |
488 |
$88K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,245 |
2,186 |
$72K |
| D0272 |
Bitewings - two radiographic images |
2,942 |
2,913 |
$63K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
407 |
197 |
$52K |
| D0330 |
Panoramic radiographic image |
737 |
727 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
729 |
716 |
$30K |
| D0274 |
Bitewings - four radiographic images |
697 |
696 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
438 |
438 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
85 |
53 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
72 |
$3K |
| D8660 |
|
15 |
15 |
$2K |
| D0240 |
|
48 |
47 |
$2K |
| D1351 |
Sealant - per tooth |
44 |
16 |
$2K |
| D0340 |
|
15 |
15 |
$918.15 |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
25 |
$904.78 |
| D0220 |
Intraoral - periapical first radiographic image |
64 |
62 |
$862.43 |
| D0470 |
|
15 |
15 |
$750.45 |
| D0350 |
|
15 |
15 |
$494.40 |