| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,456 |
2,094 |
$184K |
| D1120 |
Prophylaxis - child |
4,744 |
4,726 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
5,552 |
5,533 |
$138K |
| D1206 |
Topical application of fluoride varnish |
5,455 |
5,436 |
$117K |
| D1110 |
Prophylaxis - adult |
3,733 |
3,724 |
$108K |
| D1351 |
Sealant - per tooth |
3,834 |
736 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,426 |
2,424 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,798 |
1,785 |
$54K |
| D0330 |
Panoramic radiographic image |
1,510 |
1,503 |
$49K |
| D0274 |
Bitewings - four radiographic images |
3,619 |
3,611 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
8,894 |
8,695 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,524 |
7,454 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
546 |
383 |
$25K |
| D0272 |
Bitewings - two radiographic images |
2,540 |
2,531 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
203 |
157 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
540 |
503 |
$11K |
| D0602 |
|
918 |
914 |
$9K |
| D2954 |
|
67 |
52 |
$6K |
| D0603 |
|
523 |
520 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22 |
15 |
$2K |
| D0601 |
|
205 |
205 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
19 |
12 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
14 |
$950.00 |