| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,910 |
2,435 |
$277K |
| D1120 |
Prophylaxis - child |
6,201 |
5,924 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
8,402 |
8,033 |
$148K |
| D1110 |
Prophylaxis - adult |
3,636 |
3,452 |
$121K |
| D1999 |
|
5,967 |
4,974 |
$105K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,162 |
4,346 |
$93K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,351 |
6,130 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,405 |
1,005 |
$82K |
| D0330 |
Panoramic radiographic image |
1,800 |
1,699 |
$76K |
| D1206 |
Topical application of fluoride varnish |
3,150 |
2,923 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,050 |
652 |
$52K |
| D0272 |
Bitewings - two radiographic images |
2,937 |
2,796 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
581 |
401 |
$45K |
| D0274 |
Bitewings - four radiographic images |
2,045 |
1,961 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,514 |
1,425 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,113 |
989 |
$27K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
179 |
119 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,090 |
943 |
$10K |
| D1351 |
Sealant - per tooth |
221 |
58 |
$5K |
| D3120 |
|
70 |
57 |
$2K |
| D1354 |
|
40 |
12 |
$1K |