| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,703 |
3,449 |
$481K |
| D1120 |
Prophylaxis - child |
14,673 |
14,045 |
$392K |
| D0120 |
Periodic oral evaluation - established patient |
19,927 |
19,109 |
$358K |
| D2740 |
Crown - porcelain/ceramic |
753 |
428 |
$292K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,521 |
18,662 |
$270K |
| D1110 |
Prophylaxis - adult |
7,570 |
7,186 |
$259K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,208 |
2,282 |
$251K |
| D0330 |
Panoramic radiographic image |
5,339 |
5,023 |
$219K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,488 |
1,465 |
$215K |
| D1999 |
|
10,833 |
9,708 |
$195K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
373 |
290 |
$192K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,815 |
5,041 |
$110K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,621 |
4,035 |
$106K |
| D0274 |
Bitewings - four radiographic images |
4,234 |
4,009 |
$92K |
| D0140 |
Limited oral evaluation - problem focused |
3,331 |
3,026 |
$86K |
| D1206 |
Topical application of fluoride varnish |
3,793 |
3,570 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
8,966 |
7,689 |
$79K |
| D2394 |
|
694 |
493 |
$78K |
| D7240 |
Removal of impacted tooth - completely bony |
443 |
109 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,398 |
3,177 |
$76K |
| D0272 |
Bitewings - two radiographic images |
4,140 |
3,965 |
$69K |
| D2950 |
|
619 |
379 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
958 |
466 |
$45K |
| D7230 |
|
248 |
58 |
$37K |
| D0240 |
|
1,532 |
778 |
$26K |
| D1351 |
Sealant - per tooth |
1,069 |
369 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
223 |
104 |
$13K |
| D3320 |
|
20 |
12 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
353 |
322 |
$7K |
| D3120 |
|
105 |
74 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
260 |
175 |
$0.00 |