| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,108 |
1,239 |
$276K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,076 |
593 |
$262K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
967 |
480 |
$96K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,414 |
1,963 |
$93K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,645 |
679 |
$92K |
| D1120 |
Prophylaxis - child |
3,580 |
3,095 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
3,413 |
2,943 |
$77K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,018 |
512 |
$71K |
| D1206 |
Topical application of fluoride varnish |
4,138 |
3,554 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
956 |
828 |
$37K |
| D1351 |
Sealant - per tooth |
1,263 |
430 |
$31K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
399 |
168 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
808 |
694 |
$26K |
| D3240 |
|
163 |
93 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,636 |
1,403 |
$25K |
| D2390 |
|
134 |
39 |
$22K |
| D1110 |
Prophylaxis - adult |
641 |
560 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,651 |
1,362 |
$21K |
| D9420 |
|
216 |
164 |
$20K |
| D0240 |
|
1,348 |
633 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,697 |
722 |
$17K |
| D0330 |
Panoramic radiographic image |
206 |
176 |
$8K |
| D0274 |
Bitewings - four radiographic images |
257 |
224 |
$7K |
| D2332 |
|
122 |
24 |
$6K |
| D1510 |
|
29 |
24 |
$6K |
| D2330 |
|
56 |
25 |
$3K |