| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,146 |
2,119 |
$271K |
| D1120 |
Prophylaxis - child |
7,917 |
7,806 |
$215K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,282 |
1,853 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
7,765 |
7,620 |
$158K |
| D1351 |
Sealant - per tooth |
7,848 |
2,025 |
$144K |
| D0274 |
Bitewings - four radiographic images |
5,599 |
5,446 |
$125K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,798 |
9,573 |
$122K |
| D1110 |
Prophylaxis - adult |
3,153 |
3,017 |
$111K |
| D7240 |
Removal of impacted tooth - completely bony |
587 |
183 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,395 |
3,280 |
$95K |
| D0272 |
Bitewings - two radiographic images |
3,973 |
3,892 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
718 |
468 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
5,395 |
5,228 |
$46K |
| D0145 |
Oral evaluation for a patient under three years of age |
621 |
616 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,317 |
4,087 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
481 |
478 |
$25K |
| D0330 |
Panoramic radiographic image |
1,834 |
1,782 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
939 |
830 |
$18K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
138 |
75 |
$15K |
| D1206 |
Topical application of fluoride varnish |
397 |
396 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
180 |
162 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
12 |
$1K |
| D0270 |
|
150 |
141 |
$688.41 |
| D1999 |
|
60 |
48 |
$0.00 |
| D0601 |
|
452 |
419 |
$0.00 |
| D0603 |
|
5,706 |
5,517 |
$0.00 |
| D0602 |
|
961 |
862 |
$0.00 |