| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,848 |
4,663 |
$1.72M |
| D1351 |
Sealant - per tooth |
39,422 |
7,551 |
$1.68M |
| D1120 |
Prophylaxis - child |
26,721 |
25,326 |
$1.40M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,453 |
2,687 |
$1.35M |
| D3240 |
|
5,146 |
2,572 |
$1.25M |
| D0120 |
Periodic oral evaluation - established patient |
28,915 |
27,776 |
$1.19M |
| D1206 |
Topical application of fluoride varnish |
34,239 |
32,458 |
$1.09M |
| D0220 |
Intraoral - periapical first radiographic image |
35,910 |
33,926 |
$849K |
| D0272 |
Bitewings - two radiographic images |
20,023 |
18,985 |
$711K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,995 |
2,439 |
$634K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,242 |
1,603 |
$624K |
| D9248 |
|
2,402 |
2,108 |
$604K |
| D1110 |
Prophylaxis - adult |
7,212 |
6,918 |
$516K |
| D0330 |
Panoramic radiographic image |
5,934 |
5,635 |
$516K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,582 |
6,339 |
$506K |
| D0274 |
Bitewings - four radiographic images |
8,567 |
8,233 |
$444K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,190 |
1,634 |
$390K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,532 |
4,977 |
$343K |
| D0140 |
Limited oral evaluation - problem focused |
4,412 |
4,099 |
$263K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,229 |
7,581 |
$164K |
| D2330 |
|
810 |
448 |
$138K |
| D2332 |
|
534 |
365 |
$131K |
| D8670 |
Periodic orthodontic treatment visit |
549 |
393 |
$64K |
| D2933 |
|
152 |
48 |
$45K |
| D3230 |
|
157 |
51 |
$31K |
| D2331 |
|
75 |
66 |
$18K |
| D1999 |
|
1,424 |
1,293 |
$0.00 |
| D0603 |
|
34,120 |
32,533 |
$0.00 |