| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,925 |
930 |
$210K |
| D1120 |
Prophylaxis - child |
3,141 |
3,141 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
2,711 |
2,711 |
$122K |
| D0272 |
Bitewings - two radiographic images |
2,044 |
2,044 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
639 |
424 |
$64K |
| D1206 |
Topical application of fluoride varnish |
1,521 |
1,521 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,650 |
1,650 |
$41K |
| D1351 |
Sealant - per tooth |
749 |
191 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,087 |
971 |
$27K |
| D0603 |
|
1,687 |
1,687 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
876 |
872 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
182 |
182 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
143 |
142 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
384 |
382 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
18 |
13 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
40 |
40 |
$2K |
| D9920 |
|
26 |
24 |
$1K |