| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,326 |
1,476 |
$170K |
| D0330 |
Panoramic radiographic image |
1,955 |
1,858 |
$89K |
| D1120 |
Prophylaxis - child |
3,292 |
3,130 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
4,854 |
4,621 |
$86K |
| D1999 |
|
4,511 |
4,091 |
$82K |
| D1110 |
Prophylaxis - adult |
2,274 |
2,170 |
$78K |
| D1206 |
Topical application of fluoride varnish |
3,366 |
3,180 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,121 |
775 |
$65K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,255 |
2,866 |
$63K |
| D0272 |
Bitewings - two radiographic images |
2,851 |
2,701 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,833 |
1,739 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,349 |
2,255 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
1,215 |
1,118 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
356 |
239 |
$19K |
| D1351 |
Sealant - per tooth |
781 |
256 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
693 |
657 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
535 |
510 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
35 |
25 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
150 |
149 |
$1K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
18 |
12 |
$1K |