| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15,641 |
3,807 |
$949K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,441 |
3,371 |
$750K |
| D1120 |
Prophylaxis - child |
17,506 |
16,996 |
$484K |
| D0120 |
Periodic oral evaluation - established patient |
19,903 |
19,346 |
$391K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,233 |
20,557 |
$317K |
| D2335 |
|
3,469 |
1,383 |
$309K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,357 |
1,500 |
$271K |
| D0272 |
Bitewings - two radiographic images |
16,467 |
15,983 |
$257K |
| D1354 |
|
8,345 |
1,294 |
$238K |
| D1999 |
|
10,400 |
9,798 |
$187K |
| D0220 |
Intraoral - periapical first radiographic image |
16,150 |
15,523 |
$184K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,999 |
559 |
$170K |
| D3240 |
|
1,231 |
499 |
$168K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,221 |
14,407 |
$160K |
| D0240 |
|
10,331 |
5,090 |
$157K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,008 |
1,429 |
$151K |
| D1351 |
Sealant - per tooth |
6,225 |
1,846 |
$130K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,719 |
5,193 |
$114K |
| D1110 |
Prophylaxis - adult |
2,975 |
2,890 |
$113K |
| D0330 |
Panoramic radiographic image |
2,248 |
2,188 |
$110K |
| D2330 |
|
1,600 |
726 |
$80K |
| D0140 |
Limited oral evaluation - problem focused |
2,741 |
2,409 |
$72K |
| D2331 |
|
1,012 |
527 |
$63K |
| D3230 |
|
287 |
81 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,383 |
1,341 |
$28K |
| D2332 |
|
150 |
80 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
421 |
405 |
$9K |
| D1206 |
Topical application of fluoride varnish |
498 |
453 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
75 |
69 |
$2K |
| D2940 |
|
46 |
26 |
$423.00 |