| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,950 |
1,114 |
$206K |
| D1120 |
Prophylaxis - child |
5,159 |
4,985 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
4,241 |
4,136 |
$116K |
| D1206 |
Topical application of fluoride varnish |
5,257 |
5,076 |
$107K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
450 |
233 |
$68K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,263 |
2,177 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,538 |
1,432 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
907 |
418 |
$50K |
| D9920 |
|
1,090 |
1,070 |
$40K |
| D0272 |
Bitewings - two radiographic images |
4,035 |
3,899 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,098 |
940 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,688 |
2,548 |
$21K |
| D1351 |
Sealant - per tooth |
766 |
254 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
292 |
151 |
$15K |
| D0330 |
Panoramic radiographic image |
218 |
209 |
$8K |
| D1999 |
|
686 |
581 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,106 |
1,886 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
56 |
56 |
$1K |
| D9248 |
|
22 |
14 |
$1K |
| D0170 |
|
24 |
24 |
$240.00 |