| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0240 |
|
10,925 |
5,329 |
$193K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,990 |
1,089 |
$159K |
| D1120 |
Prophylaxis - child |
5,653 |
5,520 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
7,875 |
7,685 |
$147K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,985 |
8,764 |
$130K |
| D1110 |
Prophylaxis - adult |
3,159 |
3,075 |
$115K |
| D0330 |
Panoramic radiographic image |
2,168 |
2,119 |
$104K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,366 |
819 |
$77K |
| D0272 |
Bitewings - two radiographic images |
4,062 |
3,968 |
$72K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,362 |
2,956 |
$70K |
| D0274 |
Bitewings - four radiographic images |
2,249 |
2,184 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
338 |
208 |
$36K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
232 |
144 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
605 |
593 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
472 |
449 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
182 |
111 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
971 |
870 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
12 |
$142.00 |