| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
14,202 |
3,864 |
$403K |
| D1120 |
Prophylaxis - child |
7,777 |
7,309 |
$202K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,714 |
1,569 |
$199K |
| D0120 |
Periodic oral evaluation - established patient |
8,470 |
8,057 |
$154K |
| D1999 |
|
7,254 |
6,323 |
$135K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,660 |
8,038 |
$115K |
| D0330 |
Panoramic radiographic image |
2,389 |
2,185 |
$94K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
822 |
523 |
$92K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,415 |
3,766 |
$89K |
| D1110 |
Prophylaxis - adult |
2,166 |
2,032 |
$73K |
| D1206 |
Topical application of fluoride varnish |
2,600 |
2,515 |
$64K |
| D0272 |
Bitewings - two radiographic images |
3,692 |
3,461 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
827 |
539 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
769 |
531 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,904 |
1,673 |
$41K |
| D1351 |
Sealant - per tooth |
1,410 |
411 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,209 |
1,125 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,101 |
1,899 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
749 |
709 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
146 |
134 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
343 |
265 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
13 |
$2K |