| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,165 |
688 |
$166K |
| D1354 |
|
2,365 |
493 |
$63K |
| D1120 |
Prophylaxis - child |
2,248 |
2,059 |
$57K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
572 |
169 |
$56K |
| D1206 |
Topical application of fluoride varnish |
2,542 |
2,308 |
$54K |
| D1110 |
Prophylaxis - adult |
1,618 |
1,488 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
592 |
272 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
2,505 |
2,338 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
725 |
289 |
$45K |
| D1999 |
|
4,197 |
3,275 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,682 |
1,481 |
$38K |
| D0330 |
Panoramic radiographic image |
842 |
757 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,563 |
1,466 |
$22K |
| D0272 |
Bitewings - two radiographic images |
977 |
901 |
$17K |
| D0274 |
Bitewings - four radiographic images |
823 |
746 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,380 |
1,184 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
229 |
125 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
712 |
520 |
$12K |
| D2740 |
Crown - porcelain/ceramic |
21 |
13 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
13 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,066 |
483 |
$9K |
| D2394 |
|
89 |
40 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
257 |
218 |
$7K |
| D2332 |
|
77 |
38 |
$5K |
| D1351 |
Sealant - per tooth |
207 |
28 |
$3K |
| D2950 |
|
22 |
13 |
$2K |
| D0250 |
|
51 |
47 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
45 |
39 |
$739.20 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
13 |
$637.00 |