| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,852 |
1,048 |
$179K |
| D1120 |
Prophylaxis - child |
7,248 |
5,982 |
$166K |
| D1206 |
Topical application of fluoride varnish |
4,819 |
4,422 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,454 |
2,408 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
4,100 |
2,961 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
824 |
527 |
$60K |
| D1351 |
Sealant - per tooth |
2,421 |
521 |
$59K |
| D0330 |
Panoramic radiographic image |
1,265 |
1,133 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,907 |
1,617 |
$56K |
| D0272 |
Bitewings - two radiographic images |
2,827 |
2,445 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,684 |
1,552 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
295 |
207 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,326 |
1,503 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
562 |
535 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
561 |
509 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,425 |
1,295 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
144 |
82 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
981 |
712 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
51 |
51 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16 |
13 |
$2K |
| D0603 |
|
4,553 |
3,230 |
$0.00 |
| D0601 |
|
27 |
26 |
$0.00 |
| D0602 |
|
100 |
68 |
$0.00 |