| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,781 |
1,646 |
$355K |
| D1120 |
Prophylaxis - child |
9,031 |
9,018 |
$316K |
| D1206 |
Topical application of fluoride varnish |
11,532 |
11,492 |
$230K |
| D0120 |
Periodic oral evaluation - established patient |
9,124 |
9,097 |
$224K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,429 |
582 |
$179K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,488 |
3,464 |
$125K |
| D1110 |
Prophylaxis - adult |
2,604 |
2,588 |
$123K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,189 |
760 |
$115K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,585 |
3,264 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,036 |
672 |
$106K |
| D0272 |
Bitewings - two radiographic images |
4,674 |
4,662 |
$99K |
| D1351 |
Sealant - per tooth |
2,765 |
860 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
3,948 |
3,928 |
$49K |
| D0350 |
|
1,346 |
1,316 |
$46K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,353 |
1,353 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,199 |
1,193 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
819 |
815 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
648 |
644 |
$23K |
| D0330 |
Panoramic radiographic image |
255 |
255 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
121 |
75 |
$10K |
| D0240 |
|
250 |
242 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
91 |
91 |
$3K |
| D9420 |
|
14 |
14 |
$1K |