| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,944 |
2,808 |
$714K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,296 |
1,884 |
$527K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,488 |
1,435 |
$265K |
| D0120 |
Periodic oral evaluation - established patient |
4,612 |
4,328 |
$114K |
| D1120 |
Prophylaxis - child |
3,377 |
3,246 |
$90K |
| D0330 |
Panoramic radiographic image |
1,652 |
1,546 |
$90K |
| D0274 |
Bitewings - four radiographic images |
2,565 |
2,379 |
$78K |
| D2394 |
|
517 |
303 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,738 |
1,610 |
$73K |
| D1110 |
Prophylaxis - adult |
1,985 |
1,869 |
$73K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
719 |
403 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
5,013 |
4,620 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,417 |
4,163 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,553 |
1,354 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,127 |
682 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,228 |
4,017 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,629 |
1,496 |
$55K |
| D0272 |
Bitewings - two radiographic images |
1,976 |
1,888 |
$36K |
| D1351 |
Sealant - per tooth |
1,008 |
170 |
$26K |
| D0240 |
|
674 |
642 |
$21K |
| D2332 |
|
81 |
55 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16 |
12 |
$2K |
| D2335 |
|
20 |
12 |
$2K |
| D4355 |
|
14 |
12 |
$770.84 |
| D1206 |
Topical application of fluoride varnish |
31 |
29 |
$469.84 |