| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,221 |
1,469 |
$167K |
| D1120 |
Prophylaxis - child |
4,464 |
4,464 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
4,895 |
4,895 |
$122K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,477 |
4,477 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,299 |
1,978 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
267 |
178 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
461 |
348 |
$27K |
| D0603 |
|
2,511 |
2,511 |
$25K |
| D1110 |
Prophylaxis - adult |
704 |
704 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,801 |
1,801 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
305 |
191 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
495 |
491 |
$14K |
| D1206 |
Topical application of fluoride varnish |
560 |
560 |
$11K |
| D0330 |
Panoramic radiographic image |
177 |
177 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
112 |
66 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
268 |
267 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
194 |
194 |
$5K |
| D9920 |
|
154 |
143 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
52 |
26 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
412 |
409 |
$2K |