| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,014 |
2,908 |
$582K |
| D0120 |
Periodic oral evaluation - established patient |
17,680 |
15,794 |
$416K |
| D1120 |
Prophylaxis - child |
14,239 |
12,842 |
$350K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,992 |
2,151 |
$289K |
| D1206 |
Topical application of fluoride varnish |
18,253 |
16,379 |
$267K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,198 |
5,181 |
$253K |
| D1110 |
Prophylaxis - adult |
6,478 |
5,914 |
$228K |
| D1351 |
Sealant - per tooth |
5,264 |
1,477 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,903 |
2,665 |
$121K |
| D0272 |
Bitewings - two radiographic images |
5,812 |
5,212 |
$97K |
| D0274 |
Bitewings - four radiographic images |
3,043 |
2,734 |
$87K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
622 |
403 |
$78K |
| D0330 |
Panoramic radiographic image |
1,420 |
1,290 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,078 |
607 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,271 |
1,128 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
283 |
185 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,893 |
1,768 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,133 |
1,853 |
$29K |
| D1354 |
|
1,485 |
378 |
$9K |
| D2332 |
|
94 |
53 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
699 |
397 |
$8K |
| D0240 |
|
402 |
198 |
$6K |
| D1510 |
|
19 |
15 |
$3K |
| D7111 |
|
45 |
24 |
$2K |
| D2330 |
|
28 |
16 |
$2K |