| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,924 |
1,219 |
$295K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,171 |
788 |
$261K |
| D1120 |
Prophylaxis - child |
7,383 |
6,501 |
$205K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,439 |
826 |
$195K |
| D0120 |
Periodic oral evaluation - established patient |
4,711 |
4,188 |
$124K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,713 |
760 |
$123K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,067 |
6,227 |
$112K |
| D0274 |
Bitewings - four radiographic images |
4,591 |
4,078 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,587 |
2,272 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,106 |
556 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
1,146 |
1,017 |
$44K |
| D0330 |
Panoramic radiographic image |
1,203 |
1,049 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,065 |
2,452 |
$37K |
| D0272 |
Bitewings - two radiographic images |
2,113 |
1,861 |
$34K |
| D9248 |
|
1,043 |
881 |
$21K |
| D1351 |
Sealant - per tooth |
649 |
145 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
988 |
864 |
$12K |
| D1206 |
Topical application of fluoride varnish |
109 |
98 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
38 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
43 |
39 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
93 |
78 |
$786.82 |
| D1110 |
Prophylaxis - adult |
75 |
68 |
$427.94 |