| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
8,751 |
3,123 |
$815K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,340 |
1,613 |
$629K |
| D1120 |
Prophylaxis - child |
7,667 |
7,328 |
$215K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,553 |
1,837 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
9,686 |
9,255 |
$182K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,748 |
11,216 |
$170K |
| D1999 |
|
7,937 |
6,986 |
$144K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,712 |
5,143 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,526 |
957 |
$120K |
| D1110 |
Prophylaxis - adult |
3,284 |
3,136 |
$119K |
| D0330 |
Panoramic radiographic image |
2,084 |
1,966 |
$100K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,268 |
649 |
$90K |
| D0272 |
Bitewings - two radiographic images |
4,623 |
4,353 |
$80K |
| D1351 |
Sealant - per tooth |
3,621 |
1,035 |
$68K |
| D2335 |
|
662 |
348 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
2,185 |
2,023 |
$60K |
| D0240 |
|
3,493 |
1,639 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,740 |
1,651 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,612 |
1,544 |
$38K |
| D2332 |
|
475 |
254 |
$38K |
| D1354 |
|
836 |
217 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,701 |
1,603 |
$18K |
| D1206 |
Topical application of fluoride varnish |
651 |
568 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
537 |
412 |
$5K |
| D1510 |
|
32 |
26 |
$5K |
| D2331 |
|
19 |
15 |
$1K |
| D9248 |
|
459 |
408 |
$833.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
28 |
26 |
$631.60 |