| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,561 |
4,286 |
$942K |
| D1120 |
Prophylaxis - child |
19,400 |
19,121 |
$848K |
| D0120 |
Periodic oral evaluation - established patient |
22,396 |
22,065 |
$665K |
| D1351 |
Sealant - per tooth |
18,735 |
4,195 |
$640K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,054 |
21,704 |
$504K |
| D9248 |
|
2,447 |
2,185 |
$451K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,571 |
2,318 |
$348K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,862 |
1,735 |
$317K |
| D1110 |
Prophylaxis - adult |
4,734 |
4,660 |
$289K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,172 |
554 |
$189K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
851 |
669 |
$134K |
| D0330 |
Panoramic radiographic image |
2,980 |
2,947 |
$128K |
| D0272 |
Bitewings - two radiographic images |
7,592 |
7,466 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,791 |
1,772 |
$95K |
| D0274 |
Bitewings - four radiographic images |
3,875 |
3,824 |
$88K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,254 |
3,816 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
1,401 |
1,340 |
$62K |
| D1206 |
Topical application of fluoride varnish |
2,115 |
2,115 |
$56K |
| D3120 |
|
1,057 |
828 |
$36K |
| D1330 |
|
3,348 |
3,285 |
$20K |
| D0240 |
|
1,487 |
1,455 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,057 |
1,025 |
$10K |