| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,731 |
2,422 |
$474K |
| D1120 |
Prophylaxis - child |
8,728 |
8,591 |
$395K |
| D0120 |
Periodic oral evaluation - established patient |
10,063 |
9,898 |
$305K |
| D1351 |
Sealant - per tooth |
6,899 |
2,112 |
$244K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,813 |
9,653 |
$226K |
| D1110 |
Prophylaxis - adult |
2,816 |
2,772 |
$174K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,073 |
852 |
$172K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
630 |
276 |
$99K |
| D0330 |
Panoramic radiographic image |
1,994 |
1,968 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,508 |
1,485 |
$81K |
| D0274 |
Bitewings - four radiographic images |
3,206 |
3,172 |
$74K |
| D1206 |
Topical application of fluoride varnish |
2,073 |
2,040 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
517 |
415 |
$50K |
| D0272 |
Bitewings - two radiographic images |
2,912 |
2,856 |
$45K |
| D1330 |
|
6,121 |
5,997 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
685 |
664 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
203 |
89 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,432 |
1,399 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
659 |
640 |
$13K |
| D0240 |
|
634 |
621 |
$11K |
| D3120 |
|
196 |
170 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
77 |
77 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
45 |
25 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
174 |
174 |
$2K |
| D7111 |
|
14 |
12 |
$378.00 |