| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,646 |
2,989 |
$756K |
| D1120 |
Prophylaxis - child |
13,823 |
13,769 |
$458K |
| D0120 |
Periodic oral evaluation - established patient |
13,627 |
13,573 |
$327K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,098 |
1,416 |
$217K |
| D0272 |
Bitewings - two radiographic images |
9,577 |
9,529 |
$201K |
| D1110 |
Prophylaxis - adult |
3,968 |
3,955 |
$186K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,332 |
4,949 |
$166K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,371 |
12,325 |
$161K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,366 |
694 |
$135K |
| D1351 |
Sealant - per tooth |
3,291 |
868 |
$113K |
| D0210 |
Intraoral - complete series of radiographic images |
1,271 |
1,252 |
$103K |
| D1206 |
Topical application of fluoride varnish |
5,551 |
5,529 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,405 |
2,382 |
$95K |
| D0274 |
Bitewings - four radiographic images |
2,846 |
2,828 |
$87K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
487 |
247 |
$68K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,619 |
1,615 |
$51K |
| D1354 |
|
5,723 |
1,645 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
928 |
898 |
$32K |
| D8210 |
|
53 |
53 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,393 |
1,380 |
$17K |
| D2940 |
|
199 |
77 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
564 |
560 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
26 |
$5K |
| D7960 |
|
12 |
12 |
$4K |
| D7111 |
|
25 |
14 |
$1K |