| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,532 |
1,271 |
$327K |
| D1120 |
Prophylaxis - child |
8,001 |
7,975 |
$269K |
| D0120 |
Periodic oral evaluation - established patient |
8,719 |
8,691 |
$206K |
| D1110 |
Prophylaxis - adult |
1,835 |
1,834 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,181 |
6,162 |
$80K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,242 |
2,106 |
$70K |
| D0272 |
Bitewings - two radiographic images |
2,984 |
2,973 |
$62K |
| D1206 |
Topical application of fluoride varnish |
2,901 |
2,896 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
4,265 |
4,241 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,838 |
3,824 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
459 |
262 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
919 |
918 |
$37K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
296 |
93 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
248 |
248 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
206 |
122 |
$20K |
| D0350 |
|
440 |
313 |
$17K |
| D0274 |
Bitewings - four radiographic images |
139 |
139 |
$4K |
| D1354 |
|
35 |
14 |
$205.98 |