| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,814 |
623 |
$108K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
963 |
422 |
$69K |
| D1120 |
Prophylaxis - child |
1,813 |
1,798 |
$58K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
517 |
199 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,824 |
1,811 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,136 |
2,116 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
522 |
276 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
821 |
800 |
$23K |
| D2330 |
|
365 |
178 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,442 |
1,414 |
$18K |
| D0272 |
Bitewings - two radiographic images |
912 |
905 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
180 |
81 |
$15K |
| D1110 |
Prophylaxis - adult |
340 |
337 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,417 |
1,245 |
$13K |
| D1351 |
Sealant - per tooth |
347 |
111 |
$10K |
| D0330 |
Panoramic radiographic image |
242 |
237 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
320 |
314 |
$9K |
| D1510 |
|
47 |
28 |
$7K |
| D0274 |
Bitewings - four radiographic images |
232 |
230 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
188 |
181 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
177 |
175 |
$4K |
| D9420 |
|
49 |
45 |
$0.00 |