| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
2,513 |
1,551 |
$268K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,834 |
831 |
$244K |
| D2740 |
Crown - porcelain/ceramic |
207 |
107 |
$152K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,351 |
616 |
$140K |
| D1120 |
Prophylaxis - child |
2,338 |
2,321 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,143 |
2,116 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,009 |
2,973 |
$76K |
| D1110 |
Prophylaxis - adult |
1,357 |
1,334 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,003 |
1,978 |
$56K |
| D4341 |
|
206 |
86 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,383 |
3,331 |
$44K |
| D0330 |
Panoramic radiographic image |
794 |
781 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,362 |
1,359 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,267 |
1,258 |
$38K |
| D8660 |
|
197 |
197 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
155 |
85 |
$26K |
| D2950 |
|
189 |
108 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
1,087 |
1,070 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,011 |
1,003 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,486 |
1,463 |
$19K |
| D1351 |
Sealant - per tooth |
511 |
175 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
120 |
27 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
278 |
276 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
267 |
267 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
215 |
199 |
$7K |
| D4342 |
|
37 |
15 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
12 |
$3K |
| D2331 |
|
20 |
15 |
$3K |
| D4910 |
|
12 |
12 |
$2K |
| D0460 |
|
48 |
47 |
$1K |
| D4346 |
|
27 |
26 |
$1K |
| D0340 |
|
12 |
12 |
$713.16 |
| D0190 |
|
32 |
32 |
$552.29 |