| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,686 |
2,173 |
$634K |
| D0120 |
Periodic oral evaluation - established patient |
12,902 |
12,762 |
$299K |
| D1110 |
Prophylaxis - adult |
5,961 |
5,878 |
$260K |
| D1206 |
Topical application of fluoride varnish |
14,024 |
13,856 |
$253K |
| D1120 |
Prophylaxis - child |
6,683 |
6,614 |
$214K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,004 |
1,104 |
$213K |
| D1351 |
Sealant - per tooth |
3,815 |
1,416 |
$131K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,710 |
3,582 |
$115K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
551 |
319 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
7,052 |
6,944 |
$87K |
| D0274 |
Bitewings - four radiographic images |
2,656 |
2,605 |
$78K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
596 |
247 |
$74K |
| D7140 |
Extraction, erupted tooth or exposed root |
686 |
414 |
$68K |
| D0330 |
Panoramic radiographic image |
1,212 |
1,183 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,317 |
4,241 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,577 |
2,550 |
$52K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
440 |
214 |
$37K |
| D7111 |
|
294 |
182 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
401 |
397 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
149 |
128 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
74 |
72 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
47 |
44 |
$2K |
| D0240 |
|
20 |
20 |
$764.40 |
| D0270 |
|
27 |
27 |
$76.12 |