| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,064 |
1,863 |
$539K |
| D1120 |
Prophylaxis - child |
9,247 |
9,189 |
$310K |
| D0120 |
Periodic oral evaluation - established patient |
12,400 |
12,328 |
$293K |
| D1110 |
Prophylaxis - adult |
4,141 |
4,129 |
$181K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,481 |
9,429 |
$122K |
| D0350 |
|
2,571 |
1,389 |
$96K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,999 |
2,822 |
$93K |
| D0272 |
Bitewings - two radiographic images |
4,060 |
4,028 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
5,945 |
5,893 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,325 |
5,288 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
665 |
338 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
773 |
770 |
$63K |
| D1206 |
Topical application of fluoride varnish |
2,640 |
2,630 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
674 |
674 |
$27K |
| D1351 |
Sealant - per tooth |
394 |
119 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
137 |
28 |
$17K |
| D0274 |
Bitewings - four radiographic images |
513 |
512 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
82 |
52 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$445.90 |