| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,228 |
3,011 |
$452K |
| D1351 |
Sealant - per tooth |
18,861 |
2,824 |
$411K |
| D1354 |
|
4,938 |
1,643 |
$341K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,207 |
1,909 |
$207K |
| D1120 |
Prophylaxis - child |
7,205 |
5,931 |
$192K |
| D1110 |
Prophylaxis - adult |
4,705 |
3,871 |
$186K |
| D4346 |
|
1,178 |
909 |
$177K |
| D0274 |
Bitewings - four radiographic images |
6,498 |
5,208 |
$172K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,139 |
4,986 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
8,644 |
7,114 |
$166K |
| D1206 |
Topical application of fluoride varnish |
8,163 |
6,622 |
$148K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,734 |
1,016 |
$147K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,397 |
10,262 |
$131K |
| D0220 |
Intraoral - periapical first radiographic image |
12,122 |
9,687 |
$113K |
| D0272 |
Bitewings - two radiographic images |
4,190 |
3,363 |
$74K |
| D7140 |
Extraction, erupted tooth or exposed root |
757 |
398 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,384 |
1,124 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,172 |
1,850 |
$27K |
| D0330 |
Panoramic radiographic image |
661 |
492 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
656 |
481 |
$13K |
| D4342 |
|
163 |
41 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
70 |
51 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
395 |
301 |
$9K |
| D2332 |
|
18 |
14 |
$2K |
| D2330 |
|
18 |
13 |
$1K |
| D1999 |
|
2,685 |
1,611 |
$1K |
| D9920 |
|
135 |
54 |
$794.75 |
| D0145 |
Oral evaluation for a patient under three years of age |
20 |
18 |
$602.88 |
| D0603 |
|
306 |
271 |
$0.00 |
| D1330 |
|
362 |
206 |
$0.00 |