| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,403 |
1,615 |
$201K |
| D1120 |
Prophylaxis - child |
4,049 |
4,040 |
$168K |
| D1206 |
Topical application of fluoride varnish |
3,078 |
3,069 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
3,447 |
3,441 |
$95K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
519 |
458 |
$87K |
| D0272 |
Bitewings - two radiographic images |
3,181 |
3,172 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
727 |
596 |
$53K |
| D1351 |
Sealant - per tooth |
1,659 |
568 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,385 |
1,339 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
3,248 |
3,196 |
$30K |
| D1354 |
|
1,859 |
800 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,150 |
2,132 |
$17K |
| D0603 |
|
1,708 |
1,704 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
292 |
289 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
890 |
890 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
161 |
158 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
55 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
28 |
$4K |
| D0274 |
Bitewings - four radiographic images |
166 |
166 |
$2K |
| D0330 |
Panoramic radiographic image |
55 |
55 |
$2K |