| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,563 |
988 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
3,057 |
2,939 |
$81K |
| D1120 |
Prophylaxis - child |
2,876 |
2,767 |
$76K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,897 |
1,776 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,984 |
2,864 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,723 |
1,665 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
68 |
50 |
$8K |
| D1351 |
Sealant - per tooth |
521 |
142 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
944 |
918 |
$7K |
| D1110 |
Prophylaxis - adult |
204 |
193 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
123 |
119 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
72 |
$6K |
| D1206 |
Topical application of fluoride varnish |
309 |
297 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
43 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
53 |
39 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
13 |
$104.00 |