| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,195 |
702 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
2,389 |
2,370 |
$93K |
| D1120 |
Prophylaxis - child |
1,312 |
1,307 |
$57K |
| D1351 |
Sealant - per tooth |
1,296 |
348 |
$39K |
| D1206 |
Topical application of fluoride varnish |
919 |
918 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,090 |
1,050 |
$27K |
| D9920 |
|
80 |
78 |
$7K |
| D0272 |
Bitewings - two radiographic images |
478 |
474 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
27 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19 |
13 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
280 |
271 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
96 |
96 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
51 |
51 |
$2K |
| D0603 |
|
199 |
199 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
13 |
$1K |
| D0602 |
|
59 |
59 |
$590.00 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$560.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$189.00 |
| D0601 |
|
13 |
13 |
$130.00 |