| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,687 |
938 |
$121K |
| D1120 |
Prophylaxis - child |
4,310 |
4,010 |
$117K |
| D1206 |
Topical application of fluoride varnish |
4,803 |
4,385 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
4,608 |
4,332 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,040 |
591 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,757 |
2,100 |
$57K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
546 |
348 |
$57K |
| D1999 |
|
3,349 |
2,380 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,736 |
1,525 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
449 |
290 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,471 |
2,159 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,738 |
1,572 |
$23K |
| D0330 |
Panoramic radiographic image |
615 |
534 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
855 |
727 |
$18K |
| D1110 |
Prophylaxis - adult |
471 |
422 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
901 |
880 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
456 |
429 |
$12K |
| D0274 |
Bitewings - four radiographic images |
367 |
321 |
$6K |
| D1354 |
|
112 |
63 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
45 |
27 |
$580.80 |