| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
14,014 |
11,180 |
$236K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,359 |
1,875 |
$218K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,824 |
2,097 |
$215K |
| D0120 |
Periodic oral evaluation - established patient |
12,222 |
9,666 |
$185K |
| D1120 |
Prophylaxis - child |
8,564 |
6,580 |
$183K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,888 |
6,275 |
$160K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,085 |
10,278 |
$149K |
| D1110 |
Prophylaxis - adult |
4,210 |
3,448 |
$128K |
| D0330 |
Panoramic radiographic image |
3,358 |
2,602 |
$118K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,439 |
1,255 |
$114K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
730 |
480 |
$74K |
| D0272 |
Bitewings - two radiographic images |
5,158 |
3,910 |
$67K |
| D0274 |
Bitewings - four radiographic images |
3,104 |
2,503 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
5,806 |
4,684 |
$53K |
| D3120 |
|
2,542 |
1,312 |
$52K |
| D1206 |
Topical application of fluoride varnish |
2,539 |
2,011 |
$45K |
| D2740 |
Crown - porcelain/ceramic |
88 |
63 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,290 |
1,005 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
416 |
219 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,403 |
1,051 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,387 |
2,586 |
$27K |
| D1351 |
Sealant - per tooth |
1,432 |
419 |
$27K |
| D0240 |
|
1,970 |
568 |
$16K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
16 |
$10K |
| D2954 |
|
70 |
49 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
363 |
284 |
$6K |
| D9110 |
|
80 |
80 |
$3K |
| D2335 |
|
19 |
12 |
$2K |