| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,610 |
6,224 |
$892K |
| D1120 |
Prophylaxis - child |
32,760 |
31,274 |
$858K |
| D0120 |
Periodic oral evaluation - established patient |
43,306 |
41,374 |
$773K |
| D1206 |
Topical application of fluoride varnish |
29,615 |
28,408 |
$714K |
| D1110 |
Prophylaxis - adult |
11,681 |
11,089 |
$403K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,742 |
12,746 |
$314K |
| D0330 |
Panoramic radiographic image |
6,670 |
6,345 |
$306K |
| D1999 |
|
28,080 |
25,151 |
$298K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,608 |
2,940 |
$273K |
| D0272 |
Bitewings - two radiographic images |
15,003 |
14,313 |
$246K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,544 |
13,713 |
$172K |
| D7240 |
Removal of impacted tooth - completely bony |
876 |
210 |
$139K |
| D0274 |
Bitewings - four radiographic images |
6,450 |
6,123 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,828 |
3,580 |
$108K |
| D1351 |
Sealant - per tooth |
4,742 |
1,454 |
$100K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,510 |
808 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
4,387 |
4,111 |
$45K |
| D9222 |
|
278 |
235 |
$30K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
288 |
235 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
779 |
704 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
963 |
869 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
91 |
56 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
14 |
$1K |
| D9610 |
|
16 |
13 |
$0.00 |
| D9612 |
|
50 |
37 |
$0.00 |