| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,940 |
1,723 |
$364K |
| D1120 |
Prophylaxis - child |
9,396 |
9,341 |
$317K |
| D0120 |
Periodic oral evaluation - established patient |
12,749 |
12,678 |
$305K |
| D1206 |
Topical application of fluoride varnish |
13,218 |
13,150 |
$254K |
| D1110 |
Prophylaxis - adult |
3,939 |
3,917 |
$187K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,710 |
1,078 |
$157K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,732 |
4,470 |
$143K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,045 |
341 |
$119K |
| D7140 |
Extraction, erupted tooth or exposed root |
801 |
507 |
$74K |
| D1351 |
Sealant - per tooth |
1,711 |
465 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,497 |
2,477 |
$52K |
| D0330 |
Panoramic radiographic image |
780 |
780 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
709 |
703 |
$31K |
| D0274 |
Bitewings - four radiographic images |
821 |
818 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
290 |
285 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,730 |
1,715 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,511 |
1,484 |
$21K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
248 |
88 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
204 |
201 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
140 |
140 |
$4K |
| D2331 |
|
34 |
24 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
57 |
54 |
$1K |