| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,523 |
1,567 |
$310K |
| D1120 |
Prophylaxis - child |
6,288 |
6,281 |
$257K |
| D9310 |
|
3,307 |
3,303 |
$251K |
| D1206 |
Topical application of fluoride varnish |
7,438 |
7,424 |
$201K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,308 |
4,987 |
$164K |
| D0240 |
|
7,454 |
4,067 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
4,624 |
4,619 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,286 |
2,284 |
$126K |
| D0210 |
Intraoral - complete series of radiographic images |
2,223 |
2,073 |
$104K |
| D0220 |
Intraoral - periapical first radiographic image |
5,796 |
5,745 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
856 |
596 |
$80K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
263 |
178 |
$51K |
| D1351 |
Sealant - per tooth |
1,459 |
570 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
491 |
488 |
$28K |
| D1110 |
Prophylaxis - adult |
433 |
432 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
502 |
501 |
$20K |
| D0272 |
Bitewings - two radiographic images |
804 |
801 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
172 |
128 |
$15K |
| D0274 |
Bitewings - four radiographic images |
418 |
417 |
$13K |
| D2940 |
|
82 |
56 |
$7K |
| D0330 |
Panoramic radiographic image |
73 |
73 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
27 |
$4K |
| D1354 |
|
45 |
13 |
$1K |