| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,362 |
3,477 |
$706K |
| D0120 |
Periodic oral evaluation - established patient |
17,039 |
16,917 |
$479K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,168 |
798 |
$453K |
| D1120 |
Prophylaxis - child |
11,803 |
11,717 |
$422K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,037 |
2,994 |
$416K |
| D1110 |
Prophylaxis - adult |
5,992 |
5,946 |
$317K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,675 |
17,540 |
$253K |
| D0272 |
Bitewings - two radiographic images |
10,897 |
10,812 |
$221K |
| D0274 |
Bitewings - four radiographic images |
5,588 |
5,551 |
$165K |
| D0210 |
Intraoral - complete series of radiographic images |
1,857 |
1,857 |
$129K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,833 |
4,481 |
$124K |
| D0330 |
Panoramic radiographic image |
4,525 |
4,484 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,579 |
2,539 |
$87K |
| D7140 |
Extraction, erupted tooth or exposed root |
632 |
374 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
426 |
275 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,799 |
1,775 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,130 |
2,094 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
924 |
914 |
$17K |
| D9420 |
|
214 |
212 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
668 |
436 |
$7K |
| D7111 |
|
104 |
69 |
$1K |
| D0603 |
|
17,337 |
17,175 |
$0.00 |
| D0602 |
|
5,256 |
5,225 |
$0.00 |