| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,493 |
992 |
$68K |
| D1120 |
Prophylaxis - child |
3,800 |
3,750 |
$47K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
644 |
274 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
4,315 |
4,257 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,001 |
3,944 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
654 |
420 |
$23K |
| D1110 |
Prophylaxis - adult |
1,203 |
1,182 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,468 |
1,386 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
704 |
362 |
$18K |
| D9994 |
|
4,969 |
4,897 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,655 |
2,182 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
410 |
214 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
2,411 |
2,375 |
$10K |
| D0272 |
Bitewings - two radiographic images |
1,374 |
1,355 |
$10K |
| D1351 |
Sealant - per tooth |
636 |
269 |
$8K |
| D0274 |
Bitewings - four radiographic images |
707 |
700 |
$7K |
| D1206 |
Topical application of fluoride varnish |
949 |
935 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
510 |
504 |
$5K |
| D3120 |
|
1,121 |
551 |
$5K |
| D0330 |
Panoramic radiographic image |
131 |
131 |
$4K |
| D2332 |
|
17 |
13 |
$3K |
| D1354 |
|
165 |
37 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
233 |
226 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
122 |
115 |
$1K |
| D9920 |
|
37 |
37 |
$1K |