| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,029 |
2,537 |
$549K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,682 |
2,833 |
$371K |
| D0120 |
Periodic oral evaluation - established patient |
9,007 |
8,149 |
$241K |
| D1206 |
Topical application of fluoride varnish |
10,226 |
9,153 |
$204K |
| D1120 |
Prophylaxis - child |
7,648 |
6,935 |
$166K |
| D9920 |
|
2,783 |
2,387 |
$88K |
| D1110 |
Prophylaxis - adult |
2,333 |
2,115 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,071 |
1,790 |
$75K |
| D0330 |
Panoramic radiographic image |
2,396 |
2,063 |
$71K |
| D9110 |
|
1,139 |
979 |
$64K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,141 |
1,937 |
$63K |
| D0274 |
Bitewings - four radiographic images |
4,609 |
4,007 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
7,614 |
5,869 |
$52K |
| D4346 |
|
898 |
784 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,627 |
1,393 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
458 |
341 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
631 |
382 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,056 |
827 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,989 |
5,432 |
$18K |
| D0272 |
Bitewings - two radiographic images |
2,192 |
1,976 |
$17K |
| D2331 |
|
138 |
88 |
$11K |
| D2330 |
|
147 |
80 |
$7K |
| D2332 |
|
37 |
26 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
18 |
12 |
$3K |
| D0270 |
|
313 |
231 |
$1K |
| D9630 |
|
26 |
12 |
$270.00 |