| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,403 |
1,792 |
$343K |
| D1120 |
Prophylaxis - child |
9,079 |
8,576 |
$238K |
| D1351 |
Sealant - per tooth |
8,452 |
1,978 |
$224K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,716 |
733 |
$221K |
| D0120 |
Periodic oral evaluation - established patient |
8,279 |
7,927 |
$212K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,967 |
3,368 |
$174K |
| D1206 |
Topical application of fluoride varnish |
10,156 |
9,595 |
$159K |
| D0140 |
Limited oral evaluation - problem focused |
2,901 |
2,505 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,190 |
2,004 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,007 |
3,346 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,048 |
625 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
4,640 |
4,254 |
$67K |
| D0272 |
Bitewings - two radiographic images |
3,600 |
3,332 |
$61K |
| D7140 |
Extraction, erupted tooth or exposed root |
955 |
540 |
$57K |
| D1110 |
Prophylaxis - adult |
1,539 |
1,463 |
$56K |
| D0330 |
Panoramic radiographic image |
483 |
476 |
$27K |
| D0240 |
|
1,733 |
761 |
$25K |
| D9110 |
|
342 |
326 |
$15K |
| D0274 |
Bitewings - four radiographic images |
439 |
424 |
$14K |
| D1354 |
|
1,673 |
542 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
39 |
39 |
$657.02 |
| D1999 |
|
23 |
23 |
$0.00 |