| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,939 |
1,124 |
$323K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,145 |
555 |
$253K |
| D9248 |
|
1,690 |
1,613 |
$223K |
| D1120 |
Prophylaxis - child |
4,480 |
4,328 |
$135K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,215 |
697 |
$131K |
| D1351 |
Sealant - per tooth |
5,208 |
1,487 |
$125K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,926 |
808 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
5,269 |
5,113 |
$111K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,179 |
5,989 |
$93K |
| D1110 |
Prophylaxis - adult |
1,775 |
1,735 |
$79K |
| D0274 |
Bitewings - four radiographic images |
1,933 |
1,876 |
$58K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
380 |
196 |
$52K |
| D0330 |
Panoramic radiographic image |
1,006 |
988 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
2,457 |
2,372 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,196 |
1,148 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
698 |
667 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
563 |
534 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,022 |
1,940 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
264 |
255 |
$7K |
| D3120 |
|
157 |
82 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$365.88 |