| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,649 |
1,473 |
$260K |
| D1120 |
Prophylaxis - child |
3,544 |
3,488 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
3,888 |
3,857 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
5,066 |
4,925 |
$74K |
| D1110 |
Prophylaxis - adult |
1,672 |
1,628 |
$73K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
516 |
332 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,260 |
2,217 |
$66K |
| D1206 |
Topical application of fluoride varnish |
3,964 |
3,854 |
$65K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,242 |
2,028 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,560 |
3,828 |
$34K |
| D0330 |
Panoramic radiographic image |
718 |
718 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
992 |
942 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
798 |
783 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
396 |
266 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,350 |
1,350 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
133 |
49 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
107 |
40 |
$14K |
| D1351 |
Sealant - per tooth |
541 |
201 |
$13K |
| D0272 |
Bitewings - two radiographic images |
601 |
588 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
80 |
52 |
$5K |
| D0602 |
|
531 |
500 |
$4K |
| D9310 |
|
24 |
24 |
$1K |
| D0603 |
|
32 |
32 |
$292.80 |
| D0601 |
|
26 |
26 |
$228.75 |