| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,650 |
1,310 |
$312K |
| D1120 |
Prophylaxis - child |
6,571 |
6,512 |
$276K |
| D1206 |
Topical application of fluoride varnish |
9,377 |
9,271 |
$231K |
| D0120 |
Periodic oral evaluation - established patient |
7,109 |
7,036 |
$206K |
| D1110 |
Prophylaxis - adult |
1,914 |
1,887 |
$112K |
| D1351 |
Sealant - per tooth |
3,385 |
758 |
$112K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
515 |
360 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
836 |
480 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,332 |
1,315 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
1,159 |
1,125 |
$50K |
| D0272 |
Bitewings - two radiographic images |
2,134 |
2,109 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
288 |
205 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,476 |
1,373 |
$26K |
| D0330 |
Panoramic radiographic image |
592 |
580 |
$24K |
| D1330 |
|
4,055 |
4,011 |
$24K |
| D0274 |
Bitewings - four radiographic images |
942 |
925 |
$21K |
| D3120 |
|
526 |
261 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
789 |
770 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
12 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
424 |
413 |
$4K |
| D2940 |
|
55 |
30 |
$2K |