| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,852 |
970 |
$202K |
| D1120 |
Prophylaxis - child |
3,988 |
3,876 |
$193K |
| D1206 |
Topical application of fluoride varnish |
4,256 |
4,135 |
$100K |
| D7140 |
Extraction, erupted tooth or exposed root |
743 |
430 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,301 |
2,237 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
852 |
825 |
$49K |
| D0272 |
Bitewings - two radiographic images |
1,492 |
1,455 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,332 |
1,263 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
787 |
763 |
$38K |
| D1351 |
Sealant - per tooth |
1,212 |
265 |
$34K |
| D0330 |
Panoramic radiographic image |
475 |
456 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
163 |
117 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
690 |
659 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
91 |
71 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
266 |
259 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
63 |
31 |
$9K |
| D0240 |
|
514 |
402 |
$8K |
| D1110 |
Prophylaxis - adult |
69 |
68 |
$5K |
| D9248 |
|
25 |
25 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
238 |
98 |
$3K |
| D9310 |
|
21 |
21 |
$651.00 |