| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,889 |
917 |
$120K |
| D1120 |
Prophylaxis - child |
3,149 |
2,883 |
$77K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,010 |
296 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,577 |
2,424 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,893 |
1,676 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,087 |
631 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,966 |
1,606 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
768 |
390 |
$39K |
| D1206 |
Topical application of fluoride varnish |
2,074 |
1,825 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,629 |
1,509 |
$30K |
| D1110 |
Prophylaxis - adult |
855 |
810 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,344 |
2,214 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,751 |
1,594 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,101 |
1,855 |
$21K |
| D1351 |
Sealant - per tooth |
1,136 |
321 |
$21K |
| D0274 |
Bitewings - four radiographic images |
794 |
761 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
608 |
572 |
$15K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
304 |
113 |
$14K |
| D0330 |
Panoramic radiographic image |
308 |
302 |
$10K |
| D1510 |
|
60 |
40 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
89 |
51 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
193 |
177 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
145 |
133 |
$4K |
| D2330 |
|
63 |
28 |
$2K |