| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,568 |
1,953 |
$289K |
| D1110 |
Prophylaxis - adult |
3,137 |
2,978 |
$156K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,491 |
3,331 |
$139K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,317 |
949 |
$128K |
| D0210 |
Intraoral - complete series of radiographic images |
2,616 |
1,887 |
$106K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,160 |
624 |
$102K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
698 |
366 |
$101K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,521 |
1,077 |
$90K |
| D1351 |
Sealant - per tooth |
3,241 |
503 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
3,249 |
3,110 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
2,111 |
2,004 |
$77K |
| D0274 |
Bitewings - four radiographic images |
2,274 |
2,143 |
$74K |
| D1206 |
Topical application of fluoride varnish |
3,390 |
3,245 |
$71K |
| D0330 |
Panoramic radiographic image |
1,318 |
1,250 |
$70K |
| D1120 |
Prophylaxis - child |
1,811 |
1,746 |
$64K |
| D4346 |
|
271 |
240 |
$39K |
| D2331 |
|
358 |
232 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,481 |
2,293 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,014 |
972 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
773 |
696 |
$22K |
| D2335 |
|
120 |
80 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
94 |
70 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,025 |
762 |
$11K |
| D2332 |
|
69 |
49 |
$8K |
| D2330 |
|
61 |
47 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
37 |
27 |
$4K |
| D1354 |
|
68 |
25 |
$2K |
| D2394 |
|
15 |
13 |
$2K |