| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,243 |
1,874 |
$677K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,011 |
1,515 |
$368K |
| D1120 |
Prophylaxis - child |
5,156 |
4,973 |
$312K |
| D1351 |
Sealant - per tooth |
6,904 |
1,368 |
$303K |
| D0120 |
Periodic oral evaluation - established patient |
5,711 |
5,495 |
$257K |
| D1206 |
Topical application of fluoride varnish |
5,514 |
5,307 |
$146K |
| D1110 |
Prophylaxis - adult |
1,482 |
1,389 |
$117K |
| D0272 |
Bitewings - two radiographic images |
3,028 |
2,914 |
$115K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,867 |
1,634 |
$95K |
| D0140 |
Limited oral evaluation - problem focused |
975 |
908 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
319 |
183 |
$38K |
| D0330 |
Panoramic radiographic image |
345 |
325 |
$31K |
| D9211 |
|
489 |
436 |
$30K |
| D0274 |
Bitewings - four radiographic images |
378 |
362 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
296 |
275 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
260 |
232 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
67 |
26 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
319 |
308 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
40 |
29 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
82 |
67 |
$2K |
| D0240 |
|
66 |
30 |
$2K |