| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,667 |
2,248 |
$633K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,098 |
1,589 |
$302K |
| D1120 |
Prophylaxis - child |
9,242 |
9,222 |
$299K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,941 |
765 |
$244K |
| D0120 |
Periodic oral evaluation - established patient |
9,547 |
9,515 |
$226K |
| D1206 |
Topical application of fluoride varnish |
12,086 |
12,047 |
$224K |
| D1351 |
Sealant - per tooth |
6,232 |
1,872 |
$216K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,724 |
1,018 |
$181K |
| D9248 |
|
1,271 |
1,269 |
$177K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,069 |
557 |
$171K |
| D1110 |
Prophylaxis - adult |
3,006 |
2,990 |
$133K |
| D3120 |
|
3,548 |
929 |
$133K |
| D3240 |
|
776 |
352 |
$109K |
| D0272 |
Bitewings - two radiographic images |
4,335 |
4,322 |
$90K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,411 |
2,382 |
$75K |
| D0330 |
Panoramic radiographic image |
1,144 |
1,140 |
$60K |
| D2330 |
|
552 |
186 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,326 |
1,325 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,335 |
1,325 |
$40K |
| D2934 |
|
217 |
80 |
$38K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,133 |
1,128 |
$36K |
| D9219 |
|
890 |
884 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,446 |
2,406 |
$31K |
| D3230 |
|
220 |
82 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
757 |
750 |
$26K |
| D1510 |
|
146 |
122 |
$21K |
| D2394 |
|
101 |
75 |
$19K |
| D2335 |
|
42 |
26 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
270 |
265 |
$4K |
| D9420 |
|
36 |
36 |
$4K |
| D2332 |
|
22 |
12 |
$3K |
| D0240 |
|
56 |
56 |
$2K |