| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,865 |
1,018 |
$259K |
| D1120 |
Prophylaxis - child |
5,753 |
5,736 |
$179K |
| D0120 |
Periodic oral evaluation - established patient |
7,253 |
7,237 |
$165K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,452 |
795 |
$143K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,011 |
423 |
$124K |
| D1110 |
Prophylaxis - adult |
2,718 |
2,714 |
$115K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,536 |
7,981 |
$105K |
| D0220 |
Intraoral - periapical first radiographic image |
8,351 |
8,315 |
$103K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,112 |
6,101 |
$75K |
| D0272 |
Bitewings - two radiographic images |
3,390 |
3,382 |
$70K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
786 |
323 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,657 |
1,505 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,316 |
1,315 |
$39K |
| D1206 |
Topical application of fluoride varnish |
2,250 |
2,241 |
$38K |
| D0145 |
Oral evaluation for a patient under three years of age |
668 |
665 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
185 |
118 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
602 |
597 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
449 |
447 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
299 |
290 |
$10K |
| D1351 |
Sealant - per tooth |
226 |
62 |
$8K |
| D0330 |
Panoramic radiographic image |
90 |
88 |
$5K |