| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,194 |
3,320 |
$451K |
| D1110 |
Prophylaxis - adult |
8,835 |
8,835 |
$447K |
| D1120 |
Prophylaxis - child |
11,199 |
11,199 |
$392K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,485 |
2,302 |
$361K |
| D0120 |
Periodic oral evaluation - established patient |
13,916 |
13,915 |
$325K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,760 |
18,760 |
$307K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,178 |
6,443 |
$233K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,983 |
4,983 |
$204K |
| D0272 |
Bitewings - two radiographic images |
10,286 |
10,285 |
$196K |
| D0330 |
Panoramic radiographic image |
3,038 |
3,038 |
$155K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
736 |
572 |
$95K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,329 |
1,329 |
$58K |
| D7111 |
|
667 |
467 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,061 |
1,058 |
$41K |
| D2330 |
|
453 |
325 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
312 |
232 |
$28K |
| D1351 |
Sealant - per tooth |
852 |
301 |
$26K |
| D2331 |
|
243 |
178 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,523 |
1,499 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
231 |
190 |
$19K |
| D0240 |
|
875 |
869 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
32 |
$6K |
| D0274 |
Bitewings - four radiographic images |
108 |
108 |
$3K |
| D2140 |
|
18 |
13 |
$1K |