| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,712 |
1,795 |
$283K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,790 |
703 |
$247K |
| D1120 |
Prophylaxis - child |
9,215 |
8,488 |
$239K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,722 |
4,062 |
$208K |
| D0120 |
Periodic oral evaluation - established patient |
6,627 |
6,103 |
$163K |
| D1206 |
Topical application of fluoride varnish |
10,278 |
9,454 |
$155K |
| D1351 |
Sealant - per tooth |
4,944 |
1,241 |
$134K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,903 |
2,723 |
$126K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,409 |
994 |
$109K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,479 |
691 |
$87K |
| D0272 |
Bitewings - two radiographic images |
3,573 |
3,340 |
$63K |
| D0330 |
Panoramic radiographic image |
971 |
928 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,404 |
1,282 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
2,408 |
2,176 |
$34K |
| D0240 |
|
1,830 |
871 |
$28K |
| D1110 |
Prophylaxis - adult |
732 |
702 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
868 |
406 |
$10K |
| D2390 |
|
49 |
13 |
$9K |
| D0274 |
Bitewings - four radiographic images |
255 |
251 |
$8K |
| D9420 |
|
56 |
55 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
179 |
178 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
26 |
$4K |
| D1354 |
|
205 |
88 |
$2K |
| D2330 |
|
16 |
12 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
14 |
12 |
$1K |
| D9987 |
|
1,729 |
1,602 |
$0.00 |
| D9986 |
|
2,772 |
2,644 |
$0.00 |