| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
531 |
386 |
$62K |
| D1120 |
Prophylaxis - child |
1,058 |
1,049 |
$41K |
| D1206 |
Topical application of fluoride varnish |
990 |
989 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
662 |
657 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
208 |
158 |
$19K |
| D0272 |
Bitewings - two radiographic images |
435 |
430 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
529 |
518 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
46 |
39 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
157 |
157 |
$9K |
| D1351 |
Sealant - per tooth |
271 |
145 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
108 |
104 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
18 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
133 |
69 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
61 |
53 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$1K |
| D0240 |
|
55 |
29 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
889 |
841 |
$0.00 |