| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,860 |
997 |
$155K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,482 |
725 |
$99K |
| D1120 |
Prophylaxis - child |
2,708 |
2,690 |
$86K |
| D9310 |
|
903 |
891 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
3,394 |
3,374 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,883 |
2,874 |
$59K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,660 |
1,582 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
809 |
532 |
$56K |
| D0272 |
Bitewings - two radiographic images |
1,844 |
1,825 |
$36K |
| D1110 |
Prophylaxis - adult |
666 |
663 |
$30K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
116 |
53 |
$15K |
| D1206 |
Topical application of fluoride varnish |
263 |
257 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
446 |
443 |
$5K |
| D0274 |
Bitewings - four radiographic images |
114 |
114 |
$3K |
| D9248 |
|
28 |
28 |
$3K |
| D1351 |
Sealant - per tooth |
101 |
38 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
213 |
75 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$225.96 |