| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,788 |
4,096 |
$1.62M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,317 |
1,131 |
$873K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,082 |
2,786 |
$764K |
| D1351 |
Sealant - per tooth |
15,261 |
3,686 |
$640K |
| D1120 |
Prophylaxis - child |
10,355 |
9,971 |
$543K |
| D1206 |
Topical application of fluoride varnish |
15,155 |
14,387 |
$449K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,395 |
1,042 |
$419K |
| D0120 |
Periodic oral evaluation - established patient |
9,650 |
9,182 |
$390K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,719 |
4,228 |
$344K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,053 |
1,013 |
$336K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
264 |
203 |
$325K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,739 |
4,580 |
$298K |
| D1110 |
Prophylaxis - adult |
4,000 |
3,842 |
$280K |
| D1354 |
|
5,510 |
1,678 |
$224K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,509 |
4,501 |
$188K |
| D0240 |
|
6,660 |
3,085 |
$187K |
| D0330 |
Panoramic radiographic image |
2,106 |
1,990 |
$163K |
| D0274 |
Bitewings - four radiographic images |
3,248 |
3,122 |
$159K |
| D0272 |
Bitewings - two radiographic images |
4,108 |
3,894 |
$142K |
| D0220 |
Intraoral - periapical first radiographic image |
5,908 |
5,508 |
$136K |
| D0350 |
|
2,752 |
2,551 |
$119K |
| D9920 |
|
803 |
751 |
$106K |
| D3120 |
|
1,655 |
934 |
$62K |
| D0170 |
|
908 |
875 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
758 |
727 |
$46K |
| D9222 |
|
150 |
135 |
$38K |
| D0160 |
|
390 |
326 |
$37K |
| D2330 |
|
114 |
81 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
280 |
272 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
58 |
56 |
$6K |
| D2331 |
|
23 |
14 |
$4K |
| D0270 |
|
12 |
12 |
$190.32 |
| D0603 |
|
17,547 |
15,717 |
$0.00 |
| D0602 |
|
38 |
32 |
$0.00 |
| D9310 |
|
26 |
26 |
$0.00 |
| D1353 |
|
22 |
15 |
$0.00 |
| D1999 |
|
2,422 |
2,030 |
$0.00 |
| D9219 |
|
899 |
801 |
$0.00 |
| D9986 |
|
971 |
935 |
$0.00 |