| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,595 |
3,118 |
$482K |
| D0330 |
Panoramic radiographic image |
5,950 |
5,916 |
$360K |
| D1120 |
Prophylaxis - child |
9,477 |
9,432 |
$349K |
| D0120 |
Periodic oral evaluation - established patient |
10,599 |
10,549 |
$309K |
| D1110 |
Prophylaxis - adult |
5,783 |
5,744 |
$294K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,414 |
6,660 |
$282K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,166 |
2,328 |
$237K |
| D0272 |
Bitewings - two radiographic images |
6,829 |
6,798 |
$151K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,281 |
7,245 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,173 |
3,083 |
$147K |
| D1206 |
Topical application of fluoride varnish |
5,348 |
5,327 |
$144K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
648 |
509 |
$90K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
596 |
343 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
7,559 |
6,336 |
$66K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,173 |
1,166 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,594 |
4,506 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
850 |
819 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
113 |
79 |
$8K |
| D2950 |
|
63 |
50 |
$8K |
| D1351 |
Sealant - per tooth |
242 |
72 |
$7K |
| D2931 |
|
14 |
12 |
$2K |