| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,649 |
635 |
$151K |
| D1120 |
Prophylaxis - child |
2,378 |
1,915 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,298 |
1,009 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,316 |
1,870 |
$49K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
322 |
71 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
769 |
655 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
322 |
173 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
831 |
713 |
$22K |
| D3110 |
|
318 |
137 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,372 |
1,080 |
$18K |
| D0272 |
Bitewings - two radiographic images |
664 |
561 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,254 |
445 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
322 |
289 |
$12K |
| D1351 |
Sealant - per tooth |
375 |
97 |
$9K |
| D9310 |
|
376 |
297 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
71 |
40 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
66 |
38 |
$6K |
| D0330 |
Panoramic radiographic image |
79 |
70 |
$5K |
| D1354 |
|
365 |
89 |
$3K |
| D7111 |
|
24 |
13 |
$1K |