| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,037 |
5,051 |
$505K |
| D1120 |
Prophylaxis - child |
10,465 |
10,465 |
$338K |
| D1206 |
Topical application of fluoride varnish |
11,813 |
11,768 |
$262K |
| D0120 |
Periodic oral evaluation - established patient |
11,930 |
11,930 |
$258K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,347 |
1,747 |
$204K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,852 |
2,933 |
$159K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,779 |
1,465 |
$135K |
| D0272 |
Bitewings - two radiographic images |
10,430 |
10,427 |
$134K |
| D0220 |
Intraoral - periapical first radiographic image |
9,532 |
9,497 |
$100K |
| D0240 |
|
5,934 |
5,913 |
$95K |
| D1110 |
Prophylaxis - adult |
2,179 |
2,179 |
$95K |
| D1351 |
Sealant - per tooth |
2,917 |
1,166 |
$92K |
| D2331 |
|
887 |
635 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,693 |
1,297 |
$57K |
| D1354 |
|
3,213 |
936 |
$49K |
| D2332 |
|
598 |
459 |
$47K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
562 |
490 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
787 |
724 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
1,223 |
1,222 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,653 |
1,653 |
$18K |
| D0274 |
Bitewings - four radiographic images |
809 |
809 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
641 |
641 |
$15K |
| D2330 |
|
182 |
146 |
$8K |
| D2335 |
|
80 |
67 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,346 |
1,345 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
566 |
565 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
258 |
258 |
$6K |
| D2394 |
|
49 |
49 |
$5K |
| D0270 |
|
347 |
346 |
$4K |
| D0330 |
Panoramic radiographic image |
118 |
118 |
$4K |
| D1510 |
|
25 |
25 |
$2K |
| D9110 |
|
74 |
74 |
$2K |