| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,378 |
3,161 |
$793K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,527 |
1,338 |
$682K |
| D1120 |
Prophylaxis - child |
19,511 |
19,185 |
$679K |
| D0120 |
Periodic oral evaluation - established patient |
20,086 |
19,765 |
$603K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,787 |
2,011 |
$453K |
| D1206 |
Topical application of fluoride varnish |
22,216 |
21,798 |
$333K |
| D1351 |
Sealant - per tooth |
15,910 |
3,120 |
$303K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,877 |
1,655 |
$209K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,467 |
3,402 |
$190K |
| D9248 |
|
1,831 |
1,618 |
$170K |
| D0272 |
Bitewings - two radiographic images |
8,143 |
7,996 |
$159K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,312 |
5,107 |
$117K |
| D1110 |
Prophylaxis - adult |
2,434 |
2,393 |
$106K |
| D0330 |
Panoramic radiographic image |
1,789 |
1,755 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,146 |
2,770 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
1,608 |
1,551 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,968 |
3,836 |
$42K |
| D2330 |
|
504 |
259 |
$34K |
| D0240 |
|
2,474 |
1,586 |
$26K |
| D0274 |
Bitewings - four radiographic images |
810 |
793 |
$24K |
| D7960 |
|
202 |
111 |
$18K |
| D2332 |
|
170 |
93 |
$18K |
| D9420 |
|
135 |
128 |
$12K |
| D3120 |
|
376 |
253 |
$8K |
| D2331 |
|
46 |
27 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
103 |
103 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
14 |
$2K |
| D2335 |
|
19 |
12 |
$2K |
| D1330 |
|
39 |
39 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
13 |
$324.73 |