| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,943 |
2,318 |
$437K |
| D1120 |
Prophylaxis - child |
12,563 |
12,371 |
$412K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,484 |
1,109 |
$367K |
| D0120 |
Periodic oral evaluation - established patient |
15,366 |
15,130 |
$365K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,969 |
2,186 |
$362K |
| D1206 |
Topical application of fluoride varnish |
10,663 |
10,431 |
$222K |
| D1110 |
Prophylaxis - adult |
3,962 |
3,905 |
$170K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,842 |
1,571 |
$151K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,849 |
4,680 |
$137K |
| D0220 |
Intraoral - periapical first radiographic image |
10,769 |
10,427 |
$132K |
| D1351 |
Sealant - per tooth |
3,755 |
1,189 |
$111K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,884 |
5,856 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,510 |
9,178 |
$106K |
| D0272 |
Bitewings - two radiographic images |
5,756 |
5,672 |
$100K |
| D0330 |
Panoramic radiographic image |
2,269 |
2,228 |
$97K |
| D0274 |
Bitewings - four radiographic images |
2,424 |
2,390 |
$65K |
| D2330 |
|
842 |
434 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,429 |
1,408 |
$39K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
331 |
165 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,035 |
1,009 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
277 |
202 |
$23K |
| D1510 |
|
91 |
78 |
$14K |
| D9110 |
|
431 |
401 |
$11K |
| D2932 |
|
74 |
28 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
326 |
322 |
$7K |
| D0707 |
|
27 |
26 |
$0.00 |
| D9420 |
|
12 |
12 |
$0.00 |