| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,949 |
1,057 |
$130K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,478 |
888 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
1,937 |
1,883 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
940 |
426 |
$47K |
| D1120 |
Prophylaxis - child |
1,807 |
1,771 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,595 |
2,476 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
372 |
254 |
$32K |
| D1206 |
Topical application of fluoride varnish |
2,315 |
2,259 |
$31K |
| D2332 |
|
366 |
203 |
$26K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
283 |
135 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,704 |
2,620 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
568 |
555 |
$22K |
| D1110 |
Prophylaxis - adult |
562 |
541 |
$16K |
| D0330 |
Panoramic radiographic image |
477 |
456 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
666 |
603 |
$15K |
| D1351 |
Sealant - per tooth |
769 |
296 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,036 |
1,009 |
$14K |
| D0274 |
Bitewings - four radiographic images |
564 |
564 |
$12K |
| D2331 |
|
114 |
82 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
387 |
347 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
107 |
68 |
$6K |
| D2330 |
|
85 |
55 |
$4K |
| D3120 |
|
85 |
53 |
$2K |
| D1510 |
|
16 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
50 |
$1K |