| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
630 |
481 |
$47K |
| D1120 |
Prophylaxis - child |
1,592 |
1,568 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
719 |
443 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,868 |
1,844 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,054 |
2,023 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,317 |
1,280 |
$25K |
| D0272 |
Bitewings - two radiographic images |
790 |
782 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
241 |
151 |
$12K |
| D0330 |
Panoramic radiographic image |
253 |
249 |
$11K |
| D1110 |
Prophylaxis - adult |
311 |
307 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
534 |
518 |
$6K |
| D0274 |
Bitewings - four radiographic images |
175 |
173 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
33 |
25 |
$3K |
| D3120 |
|
103 |
68 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
82 |
80 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$968.00 |
| D1206 |
Topical application of fluoride varnish |
51 |
48 |
$708.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$348.00 |