| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,545 |
5,395 |
$1.10M |
| D1120 |
Prophylaxis - child |
16,361 |
15,921 |
$704K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,507 |
766 |
$485K |
| D1206 |
Topical application of fluoride varnish |
16,162 |
15,746 |
$439K |
| D0120 |
Periodic oral evaluation - established patient |
12,622 |
12,264 |
$409K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,972 |
1,432 |
$325K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,385 |
1,559 |
$308K |
| D0272 |
Bitewings - two radiographic images |
5,748 |
5,620 |
$173K |
| D0330 |
Panoramic radiographic image |
1,398 |
1,338 |
$109K |
| D0240 |
|
5,473 |
5,345 |
$98K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,551 |
1,417 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,369 |
5,220 |
$86K |
| D0274 |
Bitewings - four radiographic images |
1,822 |
1,755 |
$80K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
739 |
479 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
968 |
917 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
713 |
688 |
$33K |
| D1351 |
Sealant - per tooth |
774 |
377 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
414 |
411 |
$8K |
| D9420 |
|
41 |
37 |
$3K |