| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,799 |
1,285 |
$123K |
| D0120 |
Periodic oral evaluation - established patient |
3,519 |
3,418 |
$64K |
| D1120 |
Prophylaxis - child |
3,585 |
3,503 |
$58K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
694 |
146 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,413 |
2,351 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,745 |
1,655 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
364 |
341 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,341 |
1,300 |
$11K |
| D7960 |
|
157 |
86 |
$11K |
| D1999 |
|
3,304 |
3,131 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
524 |
508 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
684 |
659 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
217 |
200 |
$4K |
| D1351 |
Sealant - per tooth |
289 |
99 |
$4K |
| D1206 |
Topical application of fluoride varnish |
185 |
185 |
$4K |
| D7962 |
|
40 |
40 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
49 |
28 |
$4K |
| D7961 |
|
43 |
28 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
25 |
$676.89 |
| D9248 |
|
12 |
12 |
$500.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
251 |
183 |
$441.54 |
| D1330 |
|
43 |
43 |
$0.00 |