| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,494 |
522 |
$187K |
| D0120 |
Periodic oral evaluation - established patient |
2,439 |
2,348 |
$117K |
| D1206 |
Topical application of fluoride varnish |
2,687 |
2,544 |
$89K |
| D1120 |
Prophylaxis - child |
1,688 |
1,603 |
$88K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,193 |
1,115 |
$57K |
| D1110 |
Prophylaxis - adult |
747 |
707 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
275 |
154 |
$45K |
| D0272 |
Bitewings - two radiographic images |
886 |
846 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,047 |
998 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
933 |
455 |
$19K |
| D0274 |
Bitewings - four radiographic images |
387 |
373 |
$18K |
| D0330 |
Panoramic radiographic image |
189 |
161 |
$15K |
| D1310 |
|
206 |
206 |
$11K |
| D1330 |
|
262 |
262 |
$11K |
| D1351 |
Sealant - per tooth |
205 |
44 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
29 |
13 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
15 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
38 |
37 |
$2K |