| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,284 |
2,542 |
$618K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,517 |
1,925 |
$535K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,210 |
1,884 |
$382K |
| D0120 |
Periodic oral evaluation - established patient |
5,410 |
5,065 |
$131K |
| D1120 |
Prophylaxis - child |
3,913 |
3,670 |
$99K |
| D1110 |
Prophylaxis - adult |
2,094 |
1,984 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,810 |
4,469 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
4,894 |
4,395 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,052 |
625 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,000 |
1,828 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,775 |
3,660 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,281 |
1,064 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,343 |
1,218 |
$52K |
| D0330 |
Panoramic radiographic image |
980 |
896 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,254 |
1,154 |
$43K |
| D0272 |
Bitewings - two radiographic images |
2,316 |
2,156 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
380 |
198 |
$39K |
| D2394 |
|
179 |
107 |
$25K |
| D0240 |
|
614 |
394 |
$13K |
| D1351 |
Sealant - per tooth |
185 |
26 |
$4K |
| D4355 |
|
39 |
37 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20 |
13 |
$2K |