| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,660 |
923 |
$153K |
| D1120 |
Prophylaxis - child |
3,772 |
3,675 |
$142K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
856 |
327 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
3,202 |
3,077 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,819 |
2,713 |
$58K |
| D0272 |
Bitewings - two radiographic images |
2,149 |
2,063 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,261 |
1,146 |
$48K |
| D1206 |
Topical application of fluoride varnish |
1,737 |
1,698 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
907 |
876 |
$43K |
| D0145 |
Oral evaluation for a patient under three years of age |
559 |
550 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
439 |
257 |
$29K |
| D1110 |
Prophylaxis - adult |
526 |
497 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,738 |
1,645 |
$25K |
| D9920 |
|
369 |
318 |
$22K |
| D1351 |
Sealant - per tooth |
721 |
221 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
181 |
119 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
213 |
97 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
204 |
128 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
851 |
817 |
$15K |
| D9248 |
|
39 |
38 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
374 |
351 |
$5K |
| D0330 |
Panoramic radiographic image |
30 |
30 |
$1K |