| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,395 |
1,137 |
$193K |
| D1120 |
Prophylaxis - child |
6,657 |
6,586 |
$176K |
| D1206 |
Topical application of fluoride varnish |
7,999 |
7,914 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
5,360 |
5,295 |
$83K |
| D0272 |
Bitewings - two radiographic images |
3,484 |
3,455 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,947 |
1,824 |
$54K |
| D9920 |
|
915 |
889 |
$49K |
| D1110 |
Prophylaxis - adult |
1,107 |
1,092 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,402 |
1,389 |
$41K |
| D1351 |
Sealant - per tooth |
1,562 |
524 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
506 |
329 |
$33K |
| D0240 |
|
2,402 |
1,239 |
$27K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
156 |
67 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
432 |
243 |
$23K |
| D0330 |
Panoramic radiographic image |
384 |
384 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
708 |
703 |
$12K |
| D9630 |
|
510 |
504 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
57 |
38 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
498 |
489 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
109 |
106 |
$2K |
| D9994 |
|
1,484 |
1,464 |
$2K |
| D9248 |
|
26 |
25 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
57 |
25 |
$0.00 |