| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,463 |
1,873 |
$196K |
| D1120 |
Prophylaxis - child |
8,369 |
8,285 |
$173K |
| D1206 |
Topical application of fluoride varnish |
11,586 |
11,473 |
$147K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,096 |
592 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
10,410 |
10,309 |
$128K |
| D9630 |
|
8,580 |
8,500 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,982 |
1,326 |
$93K |
| D1351 |
Sealant - per tooth |
3,850 |
1,378 |
$93K |
| D1110 |
Prophylaxis - adult |
3,201 |
3,169 |
$92K |
| D9248 |
|
1,027 |
972 |
$72K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,162 |
2,959 |
$70K |
| D0272 |
Bitewings - two radiographic images |
5,016 |
4,968 |
$61K |
| D9920 |
|
868 |
844 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
973 |
572 |
$49K |
| D3240 |
|
228 |
130 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
347 |
254 |
$42K |
| D0240 |
|
6,766 |
3,363 |
$36K |
| D1355 |
|
1,006 |
389 |
$32K |
| D2335 |
|
183 |
89 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,082 |
1,067 |
$22K |
| D0330 |
Panoramic radiographic image |
501 |
495 |
$22K |
| D3120 |
|
1,817 |
948 |
$18K |
| D2940 |
|
480 |
211 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,133 |
2,084 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
656 |
647 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,105 |
613 |
$6K |
| D9310 |
|
39 |
39 |
$4K |
| D1510 |
|
28 |
25 |
$3K |
| D0274 |
Bitewings - four radiographic images |
82 |
82 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
16 |
$432.48 |
| D1354 |
|
1,062 |
465 |
$0.00 |
| D9994 |
|
4,788 |
4,783 |
$0.00 |