| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,994 |
1,521 |
$220K |
| D1120 |
Prophylaxis - child |
7,419 |
6,856 |
$191K |
| D0120 |
Periodic oral evaluation - established patient |
9,393 |
8,699 |
$163K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,399 |
1,419 |
$135K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,759 |
9,031 |
$129K |
| D1110 |
Prophylaxis - adult |
2,404 |
2,214 |
$80K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,874 |
3,357 |
$75K |
| D0330 |
Panoramic radiographic image |
1,686 |
1,563 |
$72K |
| D1351 |
Sealant - per tooth |
5,819 |
1,097 |
$64K |
| D0272 |
Bitewings - two radiographic images |
3,840 |
3,554 |
$62K |
| D1999 |
|
3,476 |
3,066 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
885 |
472 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,128 |
1,057 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
964 |
847 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,991 |
1,779 |
$20K |
| D1206 |
Topical application of fluoride varnish |
627 |
533 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
133 |
28 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
89 |
64 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
316 |
272 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
458 |
292 |
$4K |