| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,478 |
3,031 |
$713K |
| D1120 |
Prophylaxis - child |
15,865 |
14,718 |
$619K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,703 |
885 |
$496K |
| D0120 |
Periodic oral evaluation - established patient |
13,701 |
12,724 |
$409K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,563 |
14,395 |
$383K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,151 |
3,658 |
$217K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,175 |
1,043 |
$179K |
| D0272 |
Bitewings - two radiographic images |
6,294 |
5,831 |
$171K |
| D0140 |
Limited oral evaluation - problem focused |
3,854 |
3,546 |
$159K |
| D1351 |
Sealant - per tooth |
4,553 |
1,448 |
$154K |
| D3110 |
|
1,061 |
333 |
$99K |
| D7140 |
Extraction, erupted tooth or exposed root |
930 |
554 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,535 |
1,406 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
4,703 |
4,355 |
$77K |
| D0330 |
Panoramic radiographic image |
649 |
603 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,994 |
1,701 |
$45K |
| D9310 |
|
375 |
360 |
$11K |
| D9420 |
|
124 |
116 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
27 |
$5K |
| D1354 |
|
291 |
57 |
$2K |
| D0274 |
Bitewings - four radiographic images |
50 |
44 |
$2K |