| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,392 |
3,835 |
$446K |
| D1351 |
Sealant - per tooth |
17,455 |
4,170 |
$311K |
| D1120 |
Prophylaxis - child |
11,647 |
11,416 |
$275K |
| D0120 |
Periodic oral evaluation - established patient |
12,755 |
12,508 |
$250K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,984 |
3,230 |
$250K |
| D1110 |
Prophylaxis - adult |
6,475 |
6,371 |
$242K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,876 |
1,836 |
$157K |
| D0274 |
Bitewings - four radiographic images |
7,447 |
7,321 |
$144K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,300 |
14,016 |
$136K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,038 |
4,924 |
$125K |
| D0272 |
Bitewings - two radiographic images |
8,574 |
8,407 |
$110K |
| D0210 |
Intraoral - complete series of radiographic images |
1,432 |
1,426 |
$92K |
| D7240 |
Removal of impacted tooth - completely bony |
359 |
117 |
$74K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
687 |
365 |
$67K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,154 |
2,874 |
$51K |
| D0330 |
Panoramic radiographic image |
4,268 |
4,191 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
6,534 |
6,375 |
$46K |
| D1206 |
Topical application of fluoride varnish |
3,517 |
3,466 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,575 |
5,178 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
484 |
306 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
847 |
807 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
91 |
71 |
$6K |
| D9310 |
|
48 |
48 |
$204.12 |
| D0350 |
|
16 |
16 |
$128.66 |
| D7111 |
|
24 |
17 |
$124.47 |
| D0270 |
|
13 |
13 |
$48.02 |
| D1999 |
|
432 |
364 |
$0.00 |
| D0603 |
|
18,426 |
17,782 |
$0.00 |
| D0602 |
|
946 |
928 |
$0.00 |
| D0601 |
|
513 |
498 |
$0.00 |