| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,963 |
1,704 |
$389K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,836 |
537 |
$231K |
| D1120 |
Prophylaxis - child |
7,119 |
6,346 |
$176K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,145 |
1,170 |
$165K |
| D0120 |
Periodic oral evaluation - established patient |
6,470 |
5,775 |
$152K |
| D1206 |
Topical application of fluoride varnish |
8,446 |
7,500 |
$123K |
| D1351 |
Sealant - per tooth |
3,762 |
1,199 |
$99K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,412 |
1,900 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,636 |
559 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,826 |
1,605 |
$73K |
| D0140 |
Limited oral evaluation - problem focused |
2,059 |
1,765 |
$70K |
| D0272 |
Bitewings - two radiographic images |
3,028 |
2,667 |
$50K |
| D9420 |
|
452 |
387 |
$48K |
| D1110 |
Prophylaxis - adult |
1,384 |
1,220 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
2,572 |
2,218 |
$35K |
| D0330 |
Panoramic radiographic image |
662 |
572 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,280 |
1,383 |
$34K |
| D0274 |
Bitewings - four radiographic images |
579 |
489 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
256 |
196 |
$7K |
| D2332 |
|
23 |
13 |
$2K |
| D2330 |
|
22 |
14 |
$2K |