| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,483 |
1,066 |
$291K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,680 |
1,271 |
$163K |
| D0603 |
|
5,877 |
5,806 |
$140K |
| D9920 |
|
1,174 |
1,120 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
845 |
431 |
$64K |
| D1110 |
Prophylaxis - adult |
800 |
796 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,547 |
1,471 |
$54K |
| D1120 |
Prophylaxis - child |
4,819 |
4,765 |
$53K |
| D0330 |
Panoramic radiographic image |
983 |
974 |
$50K |
| D1510 |
|
123 |
92 |
$34K |
| D0240 |
|
2,118 |
1,733 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,146 |
2,497 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
312 |
312 |
$14K |
| D1206 |
Topical application of fluoride varnish |
5,569 |
5,504 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,469 |
2,261 |
$12K |
| D1351 |
Sealant - per tooth |
3,748 |
1,093 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
72 |
72 |
$10K |
| D9310 |
|
320 |
314 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
789 |
771 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
3,925 |
3,884 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
2,981 |
2,907 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,780 |
1,764 |
$4K |
| D3120 |
|
2,942 |
1,393 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
148 |
68 |
$3K |
| D1330 |
|
5,519 |
5,455 |
$2K |
| D0272 |
Bitewings - two radiographic images |
2,790 |
2,758 |
$2K |
| D2332 |
|
16 |
12 |
$923.35 |
| D0274 |
Bitewings - four radiographic images |
727 |
724 |
$397.24 |