| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
15,936 |
2,813 |
$319K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,927 |
2,527 |
$278K |
| D1120 |
Prophylaxis - child |
6,854 |
6,420 |
$178K |
| D0120 |
Periodic oral evaluation - established patient |
9,067 |
8,418 |
$155K |
| D0330 |
Panoramic radiographic image |
3,724 |
3,365 |
$154K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,213 |
1,541 |
$127K |
| D1110 |
Prophylaxis - adult |
3,280 |
2,890 |
$104K |
| D1999 |
|
5,812 |
4,747 |
$102K |
| D1351 |
Sealant - per tooth |
4,061 |
1,150 |
$93K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,663 |
3,827 |
$90K |
| D0272 |
Bitewings - two radiographic images |
5,675 |
5,409 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,123 |
5,911 |
$87K |
| D1206 |
Topical application of fluoride varnish |
4,905 |
4,251 |
$86K |
| D0274 |
Bitewings - four radiographic images |
2,984 |
2,656 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
769 |
564 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
425 |
326 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,309 |
1,174 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
892 |
760 |
$21K |
| D7240 |
Removal of impacted tooth - completely bony |
55 |
15 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,089 |
968 |
$11K |
| D3120 |
|
344 |
277 |
$6K |
| D0240 |
|
216 |
112 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
36 |
25 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
148 |
146 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
24 |
14 |
$0.00 |
| D0603 |
|
258 |
256 |
$0.00 |
| D0601 |
|
54 |
53 |
$0.00 |
| D0270 |
|
14 |
13 |
$0.00 |