| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,407 |
1,058 |
$83K |
| D1120 |
Prophylaxis - child |
5,680 |
5,591 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
5,690 |
5,610 |
$60K |
| D1206 |
Topical application of fluoride varnish |
7,259 |
7,122 |
$54K |
| D0274 |
Bitewings - four radiographic images |
3,305 |
3,263 |
$41K |
| D1351 |
Sealant - per tooth |
3,118 |
1,026 |
$31K |
| D1110 |
Prophylaxis - adult |
1,506 |
1,485 |
$29K |
| D0240 |
|
3,298 |
2,772 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
704 |
432 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,441 |
1,946 |
$19K |
| D0330 |
Panoramic radiographic image |
986 |
967 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,483 |
1,448 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,942 |
1,920 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,257 |
1,173 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,520 |
2,419 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
171 |
107 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
231 |
113 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
330 |
310 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
29 |
12 |
$3K |
| D9248 |
|
94 |
92 |
$3K |
| D0190 |
|
16 |
16 |
$0.00 |
| D0603 |
|
2,310 |
2,231 |
$0.00 |
| D0602 |
|
1,700 |
1,615 |
$0.00 |