| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,441 |
2,460 |
$1.00M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,910 |
1,987 |
$527K |
| D1120 |
Prophylaxis - child |
9,648 |
9,184 |
$486K |
| D0120 |
Periodic oral evaluation - established patient |
11,729 |
10,914 |
$462K |
| D1351 |
Sealant - per tooth |
9,927 |
3,137 |
$432K |
| D1206 |
Topical application of fluoride varnish |
11,684 |
11,189 |
$374K |
| D1110 |
Prophylaxis - adult |
3,232 |
3,086 |
$229K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,664 |
2,357 |
$185K |
| D0272 |
Bitewings - two radiographic images |
3,614 |
3,456 |
$129K |
| D0330 |
Panoramic radiographic image |
1,216 |
1,153 |
$101K |
| D0140 |
Limited oral evaluation - problem focused |
1,514 |
1,312 |
$87K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
289 |
92 |
$73K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
240 |
190 |
$72K |
| D0274 |
Bitewings - four radiographic images |
1,200 |
1,168 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
381 |
205 |
$58K |
| D1354 |
|
1,028 |
243 |
$47K |
| D0350 |
|
1,871 |
1,764 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
1,405 |
1,289 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
620 |
519 |
$33K |
| D0240 |
|
962 |
526 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
318 |
308 |
$10K |
| D0160 |
|
122 |
76 |
$8K |
| D3240 |
|
23 |
12 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36 |
14 |
$713.70 |
| D0270 |
|
26 |
25 |
$594.75 |
| D0601 |
|
315 |
305 |
$0.00 |
| D0602 |
|
2,959 |
2,805 |
$0.00 |
| D0603 |
|
9,173 |
8,640 |
$0.00 |
| D9420 |
|
58 |
53 |
$0.00 |
| D1999 |
|
805 |
696 |
$0.00 |