| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,726 |
1,278 |
$285K |
| D1110 |
Prophylaxis - adult |
2,994 |
2,994 |
$151K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,117 |
626 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
5,811 |
5,811 |
$135K |
| D1120 |
Prophylaxis - child |
3,367 |
3,367 |
$117K |
| D0274 |
Bitewings - four radiographic images |
3,233 |
3,233 |
$87K |
| D1206 |
Topical application of fluoride varnish |
4,893 |
4,893 |
$80K |
| D2394 |
|
341 |
198 |
$54K |
| D0272 |
Bitewings - two radiographic images |
2,386 |
2,386 |
$45K |
| D0330 |
Panoramic radiographic image |
898 |
894 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
304 |
160 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
734 |
721 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
856 |
840 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,342 |
1,342 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,276 |
1,253 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
153 |
102 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
82 |
44 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
462 |
305 |
$4K |
| D1351 |
Sealant - per tooth |
138 |
58 |
$4K |
| D2160 |
|
38 |
26 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
44 |
29 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
64 |
64 |
$3K |
| D0240 |
|
49 |
34 |
$821.61 |