| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,325 |
1,408 |
$224K |
| D1120 |
Prophylaxis - child |
4,090 |
4,090 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
5,006 |
5,006 |
$99K |
| D1110 |
Prophylaxis - adult |
2,134 |
2,134 |
$91K |
| D0330 |
Panoramic radiographic image |
1,438 |
1,438 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,741 |
3,741 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,100 |
1,946 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
3,462 |
3,431 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,833 |
2,435 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,578 |
1,578 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,155 |
1,155 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
448 |
307 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,476 |
1,476 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,450 |
1,450 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
516 |
510 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
102 |
76 |
$14K |
| D0602 |
|
1,184 |
1,184 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
46 |
28 |
$6K |
| D1351 |
Sealant - per tooth |
208 |
55 |
$5K |
| D0603 |
|
192 |
192 |
$2K |