| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,521 |
3,523 |
$565K |
| D1120 |
Prophylaxis - child |
18,217 |
17,460 |
$492K |
| D0120 |
Periodic oral evaluation - established patient |
16,804 |
16,131 |
$433K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,966 |
8,075 |
$388K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,853 |
19,960 |
$342K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,914 |
2,024 |
$222K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,710 |
4,470 |
$205K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,990 |
1,843 |
$181K |
| D0220 |
Intraoral - periapical first radiographic image |
10,575 |
9,763 |
$152K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,847 |
5,372 |
$135K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
981 |
662 |
$133K |
| D1351 |
Sealant - per tooth |
4,984 |
1,629 |
$133K |
| D1110 |
Prophylaxis - adult |
3,507 |
3,345 |
$132K |
| D0272 |
Bitewings - two radiographic images |
6,555 |
6,248 |
$119K |
| D0240 |
|
5,471 |
2,924 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
2,137 |
2,011 |
$78K |
| D0274 |
Bitewings - four radiographic images |
1,606 |
1,531 |
$50K |
| D0330 |
Panoramic radiographic image |
794 |
766 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
153 |
127 |
$20K |
| D1354 |
|
2,317 |
707 |
$13K |
| D0170 |
|
448 |
426 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
552 |
370 |
$8K |
| D1206 |
Topical application of fluoride varnish |
390 |
385 |
$6K |
| D2330 |
|
35 |
25 |
$2K |
| D2332 |
|
17 |
12 |
$2K |
| D1310 |
|
1,627 |
1,618 |
$0.00 |
| D1330 |
|
306 |
303 |
$0.00 |