| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,098 |
1,466 |
$251K |
| D1120 |
Prophylaxis - child |
5,307 |
5,203 |
$226K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,974 |
1,391 |
$185K |
| D0120 |
Periodic oral evaluation - established patient |
6,225 |
6,102 |
$182K |
| D1206 |
Topical application of fluoride varnish |
6,715 |
6,584 |
$165K |
| D1351 |
Sealant - per tooth |
2,613 |
1,281 |
$86K |
| D1110 |
Prophylaxis - adult |
1,159 |
1,140 |
$68K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,336 |
3,038 |
$61K |
| D0272 |
Bitewings - two radiographic images |
2,527 |
2,462 |
$38K |
| D0330 |
Panoramic radiographic image |
683 |
657 |
$28K |
| D0274 |
Bitewings - four radiographic images |
544 |
526 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
189 |
184 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
89 |
87 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
26 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21 |
12 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
309 |
301 |
$3K |
| D0240 |
|
13 |
12 |
$135.00 |