| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,168 |
1,259 |
$215K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,098 |
1,274 |
$159K |
| D1120 |
Prophylaxis - child |
5,364 |
5,008 |
$147K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,703 |
2,662 |
$112K |
| D1351 |
Sealant - per tooth |
3,078 |
779 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,527 |
4,200 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
2,690 |
2,372 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,206 |
1,841 |
$51K |
| D0330 |
Panoramic radiographic image |
1,075 |
1,006 |
$45K |
| D0272 |
Bitewings - two radiographic images |
2,410 |
2,218 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,554 |
1,470 |
$41K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
274 |
169 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,667 |
2,472 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,973 |
1,830 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
415 |
371 |
$14K |
| D1206 |
Topical application of fluoride varnish |
590 |
562 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
154 |
153 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
55 |
41 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
68 |
46 |
$6K |
| D1110 |
Prophylaxis - adult |
14 |
14 |
$780.00 |
| D1999 |
|
869 |
812 |
$0.00 |