| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
994 |
589 |
$200K |
| D0120 |
Periodic oral evaluation - established patient |
2,239 |
2,233 |
$186K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
745 |
253 |
$181K |
| D1120 |
Prophylaxis - child |
2,578 |
2,562 |
$154K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,052 |
524 |
$151K |
| D1206 |
Topical application of fluoride varnish |
2,707 |
2,690 |
$100K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,236 |
1,127 |
$95K |
| D1351 |
Sealant - per tooth |
1,020 |
434 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
301 |
167 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
484 |
476 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,023 |
1,012 |
$37K |
| D1110 |
Prophylaxis - adult |
307 |
307 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
1,202 |
1,186 |
$28K |
| D1354 |
|
1,415 |
310 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,270 |
927 |
$25K |
| D0240 |
|
560 |
309 |
$22K |
| D0603 |
|
1,568 |
1,556 |
$19K |
| D0274 |
Bitewings - four radiographic images |
289 |
289 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
78 |
52 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
190 |
189 |
$15K |
| D0330 |
Panoramic radiographic image |
147 |
145 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
26 |
$2K |