| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,736 |
2,384 |
$345K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,598 |
1,776 |
$316K |
| D1120 |
Prophylaxis - child |
5,961 |
5,864 |
$251K |
| D0120 |
Periodic oral evaluation - established patient |
7,616 |
7,489 |
$216K |
| D1206 |
Topical application of fluoride varnish |
7,398 |
7,268 |
$177K |
| D1110 |
Prophylaxis - adult |
2,493 |
2,448 |
$140K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
494 |
353 |
$77K |
| D0272 |
Bitewings - two radiographic images |
3,404 |
3,349 |
$50K |
| D0330 |
Panoramic radiographic image |
980 |
967 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
669 |
656 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
550 |
540 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,303 |
1,273 |
$27K |
| D1330 |
|
3,839 |
3,778 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
881 |
829 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
101 |
68 |
$9K |
| D2140 |
|
95 |
66 |
$6K |
| D1351 |
Sealant - per tooth |
139 |
38 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
27 |
17 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
39 |
28 |
$2K |
| D3120 |
|
54 |
42 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
193 |
191 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
16 |
$368.00 |