| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,982 |
2,082 |
$274K |
| D1110 |
Prophylaxis - adult |
4,779 |
4,772 |
$213K |
| D1351 |
Sealant - per tooth |
10,123 |
1,607 |
$200K |
| D1206 |
Topical application of fluoride varnish |
7,189 |
7,179 |
$193K |
| D1120 |
Prophylaxis - child |
4,176 |
4,170 |
$159K |
| D0120 |
Periodic oral evaluation - established patient |
5,976 |
5,972 |
$152K |
| D0330 |
Panoramic radiographic image |
2,378 |
2,369 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,331 |
796 |
$72K |
| D0140 |
Limited oral evaluation - problem focused |
1,668 |
1,614 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,722 |
2,715 |
$68K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
564 |
413 |
$47K |
| D0274 |
Bitewings - four radiographic images |
3,636 |
3,632 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
557 |
556 |
$25K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
47 |
38 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,129 |
1,042 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
4,296 |
4,203 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
328 |
200 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,826 |
2,691 |
$14K |
| D0603 |
|
1,572 |
1,569 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
398 |
398 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
123 |
77 |
$10K |
| D2954 |
|
99 |
82 |
$9K |
| D0601 |
|
886 |
886 |
$8K |
| D0272 |
Bitewings - two radiographic images |
864 |
864 |
$7K |
| D0602 |
|
760 |
758 |
$6K |
| D1353 |
|
561 |
86 |
$5K |
| D2332 |
|
60 |
31 |
$4K |
| D9920 |
|
184 |
176 |
$4K |