| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
975 |
480 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
3,820 |
3,048 |
$81K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
710 |
157 |
$76K |
| D1120 |
Prophylaxis - child |
2,948 |
2,373 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,814 |
3,060 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
590 |
349 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,026 |
845 |
$39K |
| D1351 |
Sealant - per tooth |
1,639 |
370 |
$37K |
| D1110 |
Prophylaxis - adult |
1,158 |
938 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
458 |
184 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,240 |
1,012 |
$19K |
| D9420 |
|
196 |
136 |
$16K |
| D0274 |
Bitewings - four radiographic images |
574 |
470 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
934 |
758 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
286 |
254 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
267 |
229 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
725 |
265 |
$7K |
| D0330 |
Panoramic radiographic image |
115 |
92 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
25 |
$4K |
| D0240 |
|
298 |
142 |
$4K |
| D1510 |
|
17 |
12 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
26 |
18 |
$2K |