| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,153 |
1,271 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
8,919 |
8,531 |
$165K |
| D1120 |
Prophylaxis - child |
5,899 |
5,650 |
$162K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,833 |
1,218 |
$154K |
| D1110 |
Prophylaxis - adult |
2,967 |
2,803 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,077 |
5,820 |
$86K |
| D1206 |
Topical application of fluoride varnish |
3,456 |
3,270 |
$80K |
| D0330 |
Panoramic radiographic image |
1,425 |
1,348 |
$59K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,710 |
2,326 |
$52K |
| D1999 |
|
3,451 |
3,028 |
$50K |
| D0272 |
Bitewings - two radiographic images |
3,140 |
2,957 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
527 |
204 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
811 |
740 |
$21K |
| D0274 |
Bitewings - four radiographic images |
621 |
580 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,307 |
1,072 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
336 |
306 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
48 |
12 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
560 |
198 |
$4K |