| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,451 |
1,693 |
$267K |
| D1120 |
Prophylaxis - child |
4,998 |
4,996 |
$224K |
| D0120 |
Periodic oral evaluation - established patient |
4,352 |
4,350 |
$195K |
| D1206 |
Topical application of fluoride varnish |
4,946 |
4,944 |
$158K |
| D0272 |
Bitewings - two radiographic images |
3,737 |
3,734 |
$127K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
431 |
372 |
$75K |
| D1351 |
Sealant - per tooth |
1,486 |
547 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
468 |
372 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
308 |
278 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
595 |
595 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
969 |
928 |
$24K |
| D0603 |
|
2,201 |
2,201 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
141 |
98 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
126 |
114 |
$15K |
| D9920 |
|
215 |
212 |
$11K |
| D2332 |
|
77 |
54 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
573 |
571 |
$8K |
| D0240 |
|
271 |
271 |
$5K |
| D9430 |
|
141 |
141 |
$3K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$1K |
| D0602 |
|
43 |
43 |
$430.00 |