| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,456 |
1,240 |
$321K |
| D1120 |
Prophylaxis - child |
5,923 |
5,863 |
$215K |
| D1206 |
Topical application of fluoride varnish |
7,447 |
7,354 |
$154K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,130 |
398 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
5,351 |
5,308 |
$134K |
| D1351 |
Sealant - per tooth |
3,089 |
912 |
$111K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,058 |
623 |
$108K |
| D1110 |
Prophylaxis - adult |
1,457 |
1,446 |
$72K |
| D0272 |
Bitewings - two radiographic images |
2,641 |
2,605 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,682 |
1,622 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,230 |
1,212 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
462 |
302 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,928 |
2,867 |
$37K |
| D0160 |
|
513 |
511 |
$36K |
| D9248 |
|
224 |
220 |
$32K |
| D0330 |
Panoramic radiographic image |
562 |
560 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,792 |
1,765 |
$27K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
323 |
171 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
135 |
85 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
620 |
610 |
$20K |
| D0274 |
Bitewings - four radiographic images |
593 |
589 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
317 |
310 |
$11K |
| D9219 |
|
161 |
161 |
$7K |
| D9310 |
|
152 |
152 |
$6K |
| D0350 |
|
51 |
51 |
$2K |
| D0240 |
|
12 |
12 |
$420.86 |