| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,336 |
2,578 |
$548K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,898 |
935 |
$388K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,012 |
1,109 |
$241K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,163 |
3,854 |
$193K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,457 |
1,118 |
$147K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,792 |
1,073 |
$143K |
| D1120 |
Prophylaxis - child |
5,119 |
4,932 |
$135K |
| D0120 |
Periodic oral evaluation - established patient |
4,933 |
4,848 |
$130K |
| D1206 |
Topical application of fluoride varnish |
6,479 |
6,261 |
$102K |
| D2332 |
|
815 |
316 |
$72K |
| D1351 |
Sealant - per tooth |
2,577 |
992 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,526 |
1,450 |
$67K |
| D2335 |
|
627 |
206 |
$65K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
711 |
343 |
$54K |
| D9420 |
|
517 |
433 |
$54K |
| D1110 |
Prophylaxis - adult |
1,329 |
1,298 |
$50K |
| D3240 |
|
261 |
135 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,346 |
2,259 |
$41K |
| D2390 |
|
226 |
66 |
$36K |
| D0330 |
Panoramic radiographic image |
562 |
546 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,023 |
1,904 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
723 |
687 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,346 |
1,102 |
$26K |
| D2330 |
|
361 |
176 |
$22K |
| D0274 |
Bitewings - four radiographic images |
667 |
654 |
$20K |
| D0240 |
|
918 |
458 |
$14K |
| D1510 |
|
77 |
55 |
$13K |
| D1516 |
|
14 |
13 |
$4K |
| D2331 |
|
18 |
12 |
$1K |