| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
491 |
170 |
$40K |
| D1120 |
Prophylaxis - child |
1,616 |
1,567 |
$38K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
192 |
62 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,320 |
1,277 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,624 |
1,569 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
341 |
315 |
$16K |
| D9999 |
Unspecified adjunctive procedure, by report |
242 |
240 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
204 |
163 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
67 |
26 |
$4K |
| D0272 |
Bitewings - two radiographic images |
330 |
320 |
$3K |
| D1999 |
|
218 |
203 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
13 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
74 |
$2K |
| D9920 |
|
47 |
45 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
40 |
$342.76 |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
12 |
$37.92 |