| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,609 |
1,757 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
5,972 |
5,884 |
$166K |
| D1120 |
Prophylaxis - child |
6,013 |
5,916 |
$151K |
| D1206 |
Topical application of fluoride varnish |
7,212 |
7,110 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,258 |
3,328 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,957 |
1,926 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,128 |
862 |
$76K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,879 |
2,753 |
$71K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
517 |
439 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
890 |
639 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
3,980 |
3,893 |
$43K |
| D0330 |
Panoramic radiographic image |
1,000 |
988 |
$43K |
| D1110 |
Prophylaxis - adult |
1,248 |
1,239 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
376 |
329 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,945 |
1,923 |
$31K |
| D0274 |
Bitewings - four radiographic images |
775 |
766 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
488 |
476 |
$15K |
| D1351 |
Sealant - per tooth |
398 |
127 |
$10K |
| D3120 |
|
76 |
70 |
$2K |
| D7111 |
|
17 |
13 |
$796.00 |