| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,931 |
1,374 |
$276K |
| D1351 |
Sealant - per tooth |
9,475 |
1,428 |
$233K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,137 |
1,133 |
$159K |
| D1120 |
Prophylaxis - child |
3,790 |
3,736 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
4,392 |
4,341 |
$123K |
| D1110 |
Prophylaxis - adult |
1,888 |
1,861 |
$98K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,389 |
4,964 |
$90K |
| D0274 |
Bitewings - four radiographic images |
2,970 |
2,928 |
$90K |
| D1206 |
Topical application of fluoride varnish |
4,778 |
4,712 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
5,432 |
5,249 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,150 |
1,118 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,425 |
1,402 |
$29K |
| D0330 |
Panoramic radiographic image |
930 |
913 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
311 |
311 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
528 |
471 |
$13K |
| D1330 |
|
1,281 |
1,223 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
576 |
570 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
81 |
62 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
329 |
311 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
28 |
$2K |
| D0603 |
|
2,262 |
2,243 |
$0.00 |
| D0602 |
|
4,544 |
4,499 |
$0.00 |