| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,322 |
1,531 |
$368K |
| D0120 |
Periodic oral evaluation - established patient |
7,990 |
7,960 |
$354K |
| D1110 |
Prophylaxis - adult |
4,491 |
4,457 |
$308K |
| D1206 |
Topical application of fluoride varnish |
8,198 |
8,161 |
$282K |
| D1120 |
Prophylaxis - child |
4,595 |
4,577 |
$227K |
| D0274 |
Bitewings - four radiographic images |
3,714 |
3,699 |
$178K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,963 |
959 |
$160K |
| D0330 |
Panoramic radiographic image |
1,638 |
1,627 |
$159K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,372 |
573 |
$155K |
| D0140 |
Limited oral evaluation - problem focused |
2,837 |
2,730 |
$119K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
621 |
361 |
$91K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
359 |
146 |
$80K |
| D0272 |
Bitewings - two radiographic images |
1,722 |
1,717 |
$75K |
| D1351 |
Sealant - per tooth |
1,370 |
442 |
$60K |
| D2331 |
|
424 |
170 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
2,617 |
2,580 |
$48K |
| D1310 |
|
1,081 |
1,077 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,760 |
1,590 |
$34K |
| D1330 |
|
836 |
836 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,037 |
901 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
241 |
138 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
414 |
413 |
$25K |
| D1354 |
|
568 |
238 |
$21K |
| D2394 |
|
52 |
36 |
$8K |
| D0180 |
|
80 |
78 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$3K |
| D2160 |
|
16 |
13 |
$2K |
| D2330 |
|
18 |
12 |
$2K |
| D9920 |
|
29 |
28 |
$2K |