| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,115 |
2,650 |
$530K |
| D0120 |
Periodic oral evaluation - established patient |
7,419 |
7,177 |
$187K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,369 |
1,449 |
$185K |
| D1110 |
Prophylaxis - adult |
4,380 |
4,232 |
$163K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,266 |
823 |
$159K |
| D1120 |
Prophylaxis - child |
4,430 |
4,282 |
$117K |
| D0330 |
Panoramic radiographic image |
2,626 |
2,496 |
$111K |
| D0274 |
Bitewings - four radiographic images |
3,877 |
3,698 |
$111K |
| D0220 |
Intraoral - periapical first radiographic image |
7,351 |
6,973 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,720 |
2,577 |
$103K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,427 |
6,120 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,011 |
4,853 |
$82K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,701 |
1,555 |
$73K |
| D0140 |
Limited oral evaluation - problem focused |
1,535 |
1,464 |
$54K |
| D1351 |
Sealant - per tooth |
1,965 |
488 |
$53K |
| D0272 |
Bitewings - two radiographic images |
1,845 |
1,777 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
481 |
270 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,646 |
1,577 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
209 |
92 |
$22K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
34 |
25 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17 |
12 |
$1K |