| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,035 |
532 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,536 |
2,500 |
$104K |
| D1120 |
Prophylaxis - child |
3,432 |
2,972 |
$87K |
| D1206 |
Topical application of fluoride varnish |
2,206 |
2,126 |
$52K |
| D1351 |
Sealant - per tooth |
1,451 |
282 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
260 |
187 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
865 |
814 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,728 |
1,370 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
150 |
86 |
$20K |
| D0330 |
Panoramic radiographic image |
613 |
602 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
267 |
267 |
$18K |
| D9248 |
|
296 |
285 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,205 |
855 |
$14K |
| D0274 |
Bitewings - four radiographic images |
517 |
509 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
140 |
96 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
258 |
257 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
104 |
65 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
200 |
198 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
572 |
567 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
839 |
205 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
268 |
214 |
$3K |