| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,888 |
1,330 |
$255K |
| D1351 |
Sealant - per tooth |
9,753 |
1,917 |
$247K |
| D1120 |
Prophylaxis - child |
6,381 |
6,209 |
$219K |
| D0120 |
Periodic oral evaluation - established patient |
7,461 |
7,285 |
$202K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,367 |
1,286 |
$176K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,902 |
6,736 |
$96K |
| D1110 |
Prophylaxis - adult |
1,810 |
1,780 |
$93K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
631 |
339 |
$84K |
| D0272 |
Bitewings - two radiographic images |
3,704 |
3,585 |
$81K |
| D9248 |
|
775 |
718 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
6,443 |
6,107 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,913 |
5,198 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
805 |
505 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
796 |
485 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,378 |
1,281 |
$33K |
| D0274 |
Bitewings - four radiographic images |
927 |
909 |
$29K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
291 |
136 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
644 |
599 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
1,034 |
968 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,220 |
1,180 |
$16K |
| D0330 |
Panoramic radiographic image |
276 |
266 |
$12K |
| D2332 |
|
57 |
39 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
14 |
$2K |
| D0603 |
|
1,298 |
1,287 |
$0.00 |
| D0601 |
|
2,791 |
2,721 |
$0.00 |
| D0602 |
|
5,429 |
5,223 |
$0.00 |