| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,391 |
1,984 |
$257K |
| D1351 |
Sealant - per tooth |
10,843 |
2,056 |
$212K |
| D1110 |
Prophylaxis - adult |
4,027 |
4,016 |
$152K |
| D1120 |
Prophylaxis - child |
6,121 |
6,102 |
$146K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,623 |
1,612 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
6,463 |
6,447 |
$132K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,228 |
1,467 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,805 |
3,788 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,759 |
9,732 |
$95K |
| D0274 |
Bitewings - four radiographic images |
4,382 |
4,367 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
1,093 |
1,089 |
$71K |
| D0272 |
Bitewings - two radiographic images |
4,708 |
4,693 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
6,573 |
6,509 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,213 |
5,986 |
$41K |
| D7240 |
Removal of impacted tooth - completely bony |
160 |
44 |
$35K |
| D0330 |
Panoramic radiographic image |
2,707 |
2,693 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,060 |
965 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
197 |
137 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
118 |
57 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
168 |
96 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
383 |
375 |
$6K |
| D1206 |
Topical application of fluoride varnish |
197 |
197 |
$2K |
| D7111 |
|
54 |
39 |
$481.83 |
| D0270 |
|
38 |
38 |
$139.72 |
| D0602 |
|
591 |
578 |
$0.00 |
| D0603 |
|
10,721 |
10,692 |
$0.00 |
| D0601 |
|
376 |
367 |
$0.00 |
| D1999 |
|
16 |
15 |
$0.00 |