| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,523 |
3,411 |
$655K |
| D1120 |
Prophylaxis - child |
13,493 |
13,412 |
$442K |
| D0120 |
Periodic oral evaluation - established patient |
15,163 |
15,069 |
$298K |
| D9248 |
|
2,230 |
2,152 |
$243K |
| D9920 |
|
3,364 |
3,329 |
$228K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,741 |
10,741 |
$216K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,774 |
1,800 |
$202K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,041 |
1,717 |
$202K |
| D9630 |
|
8,522 |
8,452 |
$165K |
| D1110 |
Prophylaxis - adult |
3,421 |
3,399 |
$157K |
| D0272 |
Bitewings - two radiographic images |
7,132 |
7,098 |
$140K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,987 |
3,809 |
$133K |
| D1206 |
Topical application of fluoride varnish |
6,136 |
6,033 |
$127K |
| D1351 |
Sealant - per tooth |
3,334 |
1,256 |
$106K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
486 |
312 |
$55K |
| D0330 |
Panoramic radiographic image |
1,037 |
1,020 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,466 |
1,458 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,819 |
3,740 |
$42K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
279 |
168 |
$38K |
| D3120 |
|
1,985 |
1,085 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,122 |
1,098 |
$27K |
| D1355 |
|
739 |
253 |
$24K |
| D3240 |
|
96 |
63 |
$20K |
| D0274 |
Bitewings - four radiographic images |
735 |
729 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,632 |
1,019 |
$18K |
| D0240 |
|
1,452 |
784 |
$17K |
| D2940 |
|
229 |
102 |
$9K |
| D2335 |
|
66 |
39 |
$9K |
| D9310 |
|
42 |
42 |
$3K |
| D2332 |
|
19 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
20 |
13 |
$948.49 |