| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,279 |
344 |
$129K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
895 |
242 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
841 |
822 |
$29K |
| D1120 |
Prophylaxis - child |
742 |
702 |
$25K |
| D1110 |
Prophylaxis - adult |
397 |
371 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,258 |
1,189 |
$17K |
| D0274 |
Bitewings - four radiographic images |
472 |
439 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,060 |
991 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,115 |
944 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
417 |
400 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
382 |
339 |
$10K |
| D0272 |
Bitewings - two radiographic images |
388 |
378 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
58 |
32 |
$8K |
| D2335 |
|
49 |
29 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
94 |
94 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
121 |
57 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$2K |
| D0603 |
|
165 |
162 |
$0.00 |
| D0602 |
|
1,131 |
1,072 |
$0.00 |