| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,553 |
3,392 |
$257K |
| D1120 |
Prophylaxis - child |
9,530 |
9,158 |
$251K |
| D0120 |
Periodic oral evaluation - established patient |
14,243 |
13,727 |
$246K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,911 |
14,331 |
$209K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,559 |
1,960 |
$187K |
| D1999 |
|
8,942 |
8,008 |
$167K |
| D1110 |
Prophylaxis - adult |
4,685 |
4,526 |
$158K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,444 |
938 |
$126K |
| D0272 |
Bitewings - two radiographic images |
7,124 |
6,817 |
$119K |
| D0330 |
Panoramic radiographic image |
2,635 |
2,505 |
$115K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,163 |
1,298 |
$110K |
| D0220 |
Intraoral - periapical first radiographic image |
10,455 |
9,982 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,538 |
8,397 |
$98K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
768 |
529 |
$59K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,814 |
2,628 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,387 |
1,313 |
$30K |
| D1351 |
Sealant - per tooth |
1,182 |
291 |
$23K |
| D1206 |
Topical application of fluoride varnish |
884 |
865 |
$22K |
| D2330 |
|
378 |
274 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
705 |
652 |
$18K |
| D0274 |
Bitewings - four radiographic images |
532 |
527 |
$12K |
| D0240 |
|
670 |
335 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
558 |
529 |
$11K |
| D2331 |
|
134 |
92 |
$9K |
| D3120 |
|
132 |
111 |
$3K |