| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,617 |
653 |
$107K |
| D1120 |
Prophylaxis - child |
3,388 |
3,384 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
2,206 |
2,203 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
858 |
858 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
782 |
421 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,383 |
3,377 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,847 |
1,676 |
$31K |
| D2335 |
|
242 |
106 |
$29K |
| D1351 |
Sealant - per tooth |
1,274 |
354 |
$27K |
| D0145 |
Oral evaluation for a patient under three years of age |
415 |
413 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,715 |
1,690 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
235 |
147 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
486 |
481 |
$19K |
| D9248 |
|
424 |
417 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
246 |
142 |
$13K |
| D9430 |
|
412 |
399 |
$13K |
| D0350 |
|
820 |
553 |
$10K |
| D2330 |
|
101 |
55 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
53 |
29 |
$5K |
| D0274 |
Bitewings - four radiographic images |
72 |
72 |
$1K |