| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,819 |
7,405 |
$1.42M |
| D0120 |
Periodic oral evaluation - established patient |
27,032 |
26,135 |
$683K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,487 |
4,936 |
$650K |
| D1110 |
Prophylaxis - adult |
16,472 |
15,921 |
$620K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,087 |
2,153 |
$380K |
| D1120 |
Prophylaxis - child |
12,961 |
12,533 |
$349K |
| D0274 |
Bitewings - four radiographic images |
11,104 |
10,619 |
$343K |
| D0330 |
Panoramic radiographic image |
6,171 |
5,876 |
$338K |
| D0220 |
Intraoral - periapical first radiographic image |
22,020 |
21,004 |
$322K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,322 |
18,904 |
$296K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,280 |
1,674 |
$263K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,140 |
12,847 |
$219K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,276 |
4,963 |
$217K |
| D1206 |
Topical application of fluoride varnish |
10,400 |
9,962 |
$165K |
| D0140 |
Limited oral evaluation - problem focused |
3,554 |
3,368 |
$126K |
| D0272 |
Bitewings - two radiographic images |
6,219 |
6,025 |
$113K |
| D1351 |
Sealant - per tooth |
4,092 |
1,086 |
$112K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,621 |
1,421 |
$72K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
335 |
189 |
$35K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
163 |
120 |
$21K |
| D2335 |
|
178 |
89 |
$20K |
| D4341 |
|
232 |
86 |
$20K |
| D2332 |
|
158 |
98 |
$15K |
| D2330 |
|
154 |
101 |
$10K |
| D2394 |
|
42 |
26 |
$5K |
| D7250 |
|
45 |
12 |
$5K |
| D7311 |
|
41 |
26 |
$4K |
| D4346 |
|
14 |
12 |
$465.96 |