| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,248 |
1,314 |
$216K |
| D1120 |
Prophylaxis - child |
7,491 |
7,217 |
$210K |
| D0120 |
Periodic oral evaluation - established patient |
8,187 |
7,908 |
$159K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,982 |
5,786 |
$90K |
| D1206 |
Topical application of fluoride varnish |
2,772 |
2,647 |
$64K |
| D1999 |
|
2,832 |
2,615 |
$53K |
| D0272 |
Bitewings - two radiographic images |
2,976 |
2,876 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
850 |
414 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,875 |
1,686 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,048 |
311 |
$32K |
| D1110 |
Prophylaxis - adult |
850 |
827 |
$31K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
265 |
76 |
$25K |
| D0330 |
Panoramic radiographic image |
528 |
490 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,153 |
1,048 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
414 |
372 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
209 |
165 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
772 |
695 |
$8K |
| D0274 |
Bitewings - four radiographic images |
260 |
255 |
$6K |
| D1351 |
Sealant - per tooth |
147 |
41 |
$4K |
| D2335 |
|
27 |
12 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
12 |
$276.50 |