| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,243 |
1,737 |
$138K |
| D1120 |
Prophylaxis - child |
5,166 |
5,106 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
4,461 |
4,409 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,566 |
2,537 |
$65K |
| D1351 |
Sealant - per tooth |
4,295 |
611 |
$56K |
| D1206 |
Topical application of fluoride varnish |
3,422 |
3,371 |
$54K |
| D9920 |
|
3,112 |
2,690 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
2,107 |
1,987 |
$42K |
| D1110 |
Prophylaxis - adult |
1,965 |
1,931 |
$41K |
| D0274 |
Bitewings - four radiographic images |
2,750 |
2,707 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
899 |
879 |
$29K |
| D8670 |
Periodic orthodontic treatment visit |
491 |
479 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
6,665 |
6,389 |
$27K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
75 |
58 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,458 |
2,430 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
670 |
429 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,543 |
5,303 |
$17K |
| D0601 |
|
1,209 |
1,170 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
215 |
157 |
$9K |
| D0272 |
Bitewings - two radiographic images |
1,278 |
1,271 |
$7K |
| D4355 |
|
108 |
107 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
185 |
131 |
$3K |
| D0330 |
Panoramic radiographic image |
157 |
157 |
$3K |
| D0603 |
|
240 |
240 |
$2K |
| D9310 |
|
130 |
130 |
$2K |
| D2954 |
|
35 |
30 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
110 |
107 |
$2K |
| D0340 |
|
72 |
72 |
$1K |
| D0602 |
|
12 |
12 |
$120.00 |
| D0350 |
|
26 |
26 |
$26.00 |
| D1999 |
|
2,506 |
2,189 |
$0.00 |