| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,744 |
2,542 |
$344K |
| D0120 |
Periodic oral evaluation - established patient |
8,747 |
8,627 |
$250K |
| D1110 |
Prophylaxis - adult |
4,599 |
4,533 |
$228K |
| D1120 |
Prophylaxis - child |
5,099 |
5,040 |
$189K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,105 |
7,026 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,547 |
1,262 |
$106K |
| D0272 |
Bitewings - two radiographic images |
4,875 |
4,790 |
$105K |
| D7140 |
Extraction, erupted tooth or exposed root |
810 |
559 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
910 |
828 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
225 |
188 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,851 |
1,638 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
218 |
214 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
694 |
673 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
65 |
53 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
68 |
53 |
$6K |
| D1206 |
Topical application of fluoride varnish |
92 |
92 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
14 |
$136.70 |