| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,322 |
1,944 |
$550K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,518 |
1,529 |
$279K |
| D0120 |
Periodic oral evaluation - established patient |
11,017 |
10,086 |
$262K |
| D1120 |
Prophylaxis - child |
10,171 |
9,181 |
$240K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,423 |
11,232 |
$181K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,322 |
445 |
$160K |
| D9420 |
|
1,551 |
1,161 |
$137K |
| D1351 |
Sealant - per tooth |
5,345 |
1,279 |
$105K |
| D0140 |
Limited oral evaluation - problem focused |
3,097 |
2,739 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,364 |
2,014 |
$88K |
| D1110 |
Prophylaxis - adult |
2,494 |
2,274 |
$85K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
880 |
372 |
$56K |
| D0330 |
Panoramic radiographic image |
1,409 |
1,244 |
$47K |
| D0272 |
Bitewings - two radiographic images |
2,996 |
2,689 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
1,339 |
1,006 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
748 |
666 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,504 |
1,280 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
103 |
54 |
$11K |
| D0274 |
Bitewings - four radiographic images |
407 |
348 |
$8K |
| D1206 |
Topical application of fluoride varnish |
762 |
622 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
82 |
44 |
$766.98 |
| D1354 |
|
57 |
26 |
$307.97 |
| D3120 |
|
182 |
75 |
$0.00 |