| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,278 |
2,122 |
$131K |
| D1120 |
Prophylaxis - child |
2,892 |
2,892 |
$116K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,468 |
1,040 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
1,940 |
1,940 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,652 |
1,827 |
$58K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
516 |
375 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
2,579 |
2,543 |
$46K |
| D0274 |
Bitewings - four radiographic images |
777 |
777 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
470 |
406 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,493 |
1,492 |
$41K |
| D2332 |
|
210 |
160 |
$34K |
| D0330 |
Panoramic radiographic image |
288 |
288 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
340 |
274 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
375 |
303 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
518 |
505 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,459 |
1,459 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
477 |
477 |
$18K |
| D1351 |
Sealant - per tooth |
347 |
213 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,439 |
1,439 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
334 |
334 |
$13K |
| D1354 |
|
1,368 |
328 |
$9K |
| D2330 |
|
59 |
42 |
$4K |
| D2335 |
|
17 |
12 |
$3K |
| D2331 |
|
13 |
12 |
$1K |