| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4342 |
|
1,293 |
469 |
$127K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
936 |
636 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,966 |
1,908 |
$81K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
327 |
180 |
$55K |
| D0330 |
Panoramic radiographic image |
917 |
879 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
454 |
351 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
280 |
215 |
$46K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
331 |
75 |
$43K |
| D1110 |
Prophylaxis - adult |
833 |
823 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,227 |
1,203 |
$37K |
| D1120 |
Prophylaxis - child |
1,019 |
991 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
964 |
948 |
$33K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
44 |
44 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,492 |
1,456 |
$30K |
| D1351 |
Sealant - per tooth |
650 |
232 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
504 |
489 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,395 |
1,367 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
685 |
684 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
433 |
366 |
$14K |
| D3320 |
|
14 |
12 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
140 |
26 |
$13K |
| D0272 |
Bitewings - two radiographic images |
564 |
542 |
$12K |
| D9310 |
|
270 |
269 |
$11K |
| D3120 |
|
209 |
136 |
$8K |
| D4346 |
|
160 |
160 |
$7K |
| D0383 |
|
45 |
45 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
18 |
$6K |
| D2940 |
|
93 |
89 |
$5K |
| D2950 |
|
28 |
24 |
$4K |
| D9243 |
|
13 |
13 |
$3K |
| D0460 |
|
91 |
90 |
$3K |
| D4910 |
|
37 |
37 |
$2K |
| D0240 |
|
55 |
55 |
$2K |
| D9239 |
|
13 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
55 |
55 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
16 |
$542.55 |