| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,944 |
638 |
$192K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,626 |
373 |
$164K |
| D1120 |
Prophylaxis - child |
2,944 |
2,941 |
$115K |
| D3240 |
|
1,461 |
333 |
$111K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,152 |
487 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
3,250 |
3,245 |
$89K |
| D2332 |
|
681 |
161 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,572 |
3,565 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,138 |
1,107 |
$39K |
| D2335 |
|
320 |
122 |
$32K |
| D1110 |
Prophylaxis - adult |
650 |
648 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,096 |
1,061 |
$27K |
| D9248 |
|
205 |
205 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,314 |
1,309 |
$24K |
| D0240 |
|
1,009 |
621 |
$15K |
| D0330 |
Panoramic radiographic image |
326 |
323 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
185 |
42 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,027 |
387 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
211 |
211 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
631 |
618 |
$8K |
| D0274 |
Bitewings - four radiographic images |
254 |
253 |
$7K |
| D2331 |
|
70 |
26 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$1K |