| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,919 |
962 |
$313K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,387 |
380 |
$193K |
| D1120 |
Prophylaxis - child |
4,981 |
4,714 |
$135K |
| D0120 |
Periodic oral evaluation - established patient |
4,036 |
3,848 |
$104K |
| D1206 |
Topical application of fluoride varnish |
5,307 |
5,019 |
$85K |
| D1351 |
Sealant - per tooth |
2,444 |
527 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,391 |
1,168 |
$63K |
| D0240 |
|
3,755 |
1,890 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,284 |
1,191 |
$58K |
| D0272 |
Bitewings - two radiographic images |
1,583 |
1,501 |
$29K |
| D9420 |
|
263 |
227 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
330 |
130 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,228 |
1,118 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
213 |
101 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
555 |
437 |
$14K |
| D0330 |
Panoramic radiographic image |
212 |
191 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
201 |
192 |
$8K |
| D1110 |
Prophylaxis - adult |
102 |
102 |
$4K |