| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,682 |
737 |
$156K |
| D0145 |
Oral evaluation for a patient under three years of age |
958 |
933 |
$128K |
| D1351 |
Sealant - per tooth |
4,951 |
1,185 |
$127K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
905 |
283 |
$123K |
| D1120 |
Prophylaxis - child |
2,879 |
2,752 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
3,242 |
3,120 |
$86K |
| D0272 |
Bitewings - two radiographic images |
2,571 |
2,460 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,683 |
3,622 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
4,061 |
3,841 |
$43K |
| D1110 |
Prophylaxis - adult |
781 |
760 |
$40K |
| D1206 |
Topical application of fluoride varnish |
2,717 |
2,597 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,399 |
1,223 |
$35K |
| D0274 |
Bitewings - four radiographic images |
969 |
933 |
$29K |
| D0350 |
|
2,255 |
2,111 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
211 |
130 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
472 |
429 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
981 |
954 |
$13K |
| D0330 |
Panoramic radiographic image |
667 |
639 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
149 |
52 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
167 |
167 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
166 |
64 |
$8K |
| D1354 |
|
424 |
50 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
298 |
284 |
$5K |
| D1330 |
|
874 |
843 |
$98.00 |
| D0601 |
|
25 |
25 |
$0.00 |
| D0602 |
|
895 |
878 |
$0.00 |
| D1310 |
|
874 |
843 |
$0.00 |
| D0603 |
|
4,128 |
4,037 |
$0.00 |