| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,363 |
3,800 |
$623K |
| D1120 |
Prophylaxis - child |
19,444 |
17,682 |
$496K |
| D0120 |
Periodic oral evaluation - established patient |
18,220 |
16,627 |
$445K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,321 |
8,138 |
$385K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,352 |
21,245 |
$363K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,175 |
1,358 |
$358K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,424 |
2,748 |
$314K |
| D1351 |
Sealant - per tooth |
9,397 |
2,493 |
$235K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,005 |
1,839 |
$217K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,188 |
4,678 |
$217K |
| D1110 |
Prophylaxis - adult |
4,501 |
4,098 |
$159K |
| D0272 |
Bitewings - two radiographic images |
8,509 |
7,776 |
$146K |
| D0140 |
Limited oral evaluation - problem focused |
4,162 |
3,724 |
$145K |
| D0220 |
Intraoral - periapical first radiographic image |
8,622 |
7,511 |
$117K |
| D0330 |
Panoramic radiographic image |
1,815 |
1,635 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,366 |
3,104 |
$75K |
| D0240 |
|
3,374 |
1,570 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,540 |
1,397 |
$45K |
| D9420 |
|
208 |
127 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
615 |
419 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
157 |
78 |
$9K |
| D1206 |
Topical application of fluoride varnish |
538 |
482 |
$7K |
| D1354 |
|
1,217 |
329 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$2K |
| D0170 |
|
19 |
19 |
$540.90 |