| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,301 |
1,383 |
$199K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,424 |
1,414 |
$153K |
| D1120 |
Prophylaxis - child |
7,363 |
6,223 |
$147K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,809 |
3,678 |
$118K |
| D1351 |
Sealant - per tooth |
5,348 |
1,350 |
$108K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,674 |
5,436 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
3,677 |
2,613 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,718 |
2,219 |
$55K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
476 |
234 |
$47K |
| D0330 |
Panoramic radiographic image |
1,316 |
1,208 |
$46K |
| D0272 |
Bitewings - two radiographic images |
3,044 |
2,577 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,822 |
1,682 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,387 |
3,067 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,487 |
2,254 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
446 |
408 |
$15K |
| D1206 |
Topical application of fluoride varnish |
617 |
567 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
162 |
162 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
68 |
54 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
106 |
73 |
$9K |
| D1999 |
|
1,307 |
1,006 |
$0.00 |