| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,255 |
2,057 |
$304K |
| D1351 |
Sealant - per tooth |
15,004 |
2,981 |
$281K |
| D1120 |
Prophylaxis - child |
8,995 |
8,739 |
$221K |
| D0120 |
Periodic oral evaluation - established patient |
9,909 |
9,626 |
$205K |
| D1110 |
Prophylaxis - adult |
4,925 |
4,773 |
$186K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,904 |
1,589 |
$157K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,809 |
12,445 |
$128K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,500 |
1,423 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,310 |
4,182 |
$111K |
| D0274 |
Bitewings - four radiographic images |
5,022 |
4,872 |
$100K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
863 |
376 |
$87K |
| D0272 |
Bitewings - two radiographic images |
5,651 |
5,478 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
1,056 |
1,056 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,214 |
2,944 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
6,336 |
6,041 |
$47K |
| D0330 |
Panoramic radiographic image |
3,271 |
3,175 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,607 |
5,208 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
481 |
333 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
255 |
155 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
576 |
557 |
$8K |
| D1206 |
Topical application of fluoride varnish |
1,014 |
952 |
$8K |
| D7240 |
Removal of impacted tooth - completely bony |
40 |
12 |
$6K |
| D7111 |
|
155 |
105 |
$1K |
| D0602 |
|
4,982 |
4,806 |
$18.01 |
| D0603 |
|
8,216 |
7,973 |
$0.06 |
| D0601 |
|
2,441 |
2,301 |
$0.00 |
| D1999 |
|
253 |
243 |
$0.00 |