| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
918 |
440 |
$98K |
| D1120 |
Prophylaxis - child |
2,832 |
2,567 |
$84K |
| D0330 |
Panoramic radiographic image |
1,370 |
1,242 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
2,522 |
2,326 |
$70K |
| D0274 |
Bitewings - four radiographic images |
1,713 |
1,529 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,077 |
994 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,229 |
2,023 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
180 |
97 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,068 |
987 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
250 |
230 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
60 |
12 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
618 |
202 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
291 |
193 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
25 |
$4K |
| D1206 |
Topical application of fluoride varnish |
70 |
68 |
$2K |