| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,590 |
3,132 |
$463K |
| D1351 |
Sealant - per tooth |
12,509 |
2,973 |
$253K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,368 |
2,364 |
$205K |
| D1120 |
Prophylaxis - child |
7,573 |
7,552 |
$193K |
| D0120 |
Periodic oral evaluation - established patient |
7,469 |
7,444 |
$157K |
| D1110 |
Prophylaxis - adult |
3,560 |
3,553 |
$136K |
| D1206 |
Topical application of fluoride varnish |
10,171 |
10,149 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,787 |
3,776 |
$98K |
| D0274 |
Bitewings - four radiographic images |
4,369 |
4,358 |
$86K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,234 |
860 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,556 |
959 |
$78K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,286 |
3,723 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
1,245 |
1,240 |
$76K |
| D0272 |
Bitewings - two radiographic images |
5,304 |
5,292 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
6,043 |
5,994 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,478 |
5,208 |
$36K |
| D0330 |
Panoramic radiographic image |
3,023 |
3,015 |
$30K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
217 |
69 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
532 |
371 |
$20K |
| D7240 |
Removal of impacted tooth - completely bony |
94 |
27 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
813 |
798 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
51 |
14 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
243 |
242 |
$1K |
| D0350 |
|
28 |
28 |
$303.27 |
| D0270 |
|
59 |
58 |
$186.90 |
| D7111 |
|
17 |
12 |
$103.28 |
| D0603 |
|
11,426 |
11,390 |
$36.10 |
| D1999 |
|
303 |
252 |
$0.00 |
| D0601 |
|
301 |
300 |
$0.00 |
| D0602 |
|
1,726 |
1,724 |
$0.00 |