| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24,774 |
6,196 |
$2.14M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,609 |
3,788 |
$1.27M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
12,010 |
3,911 |
$903K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
6,984 |
3,534 |
$656K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,572 |
3,409 |
$492K |
| D1120 |
Prophylaxis - child |
7,282 |
7,173 |
$305K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,931 |
1,773 |
$280K |
| D2332 |
|
2,425 |
1,066 |
$225K |
| D0120 |
Periodic oral evaluation - established patient |
7,590 |
7,468 |
$213K |
| D9248 |
|
3,034 |
2,858 |
$198K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,032 |
6,677 |
$171K |
| D2933 |
|
1,108 |
349 |
$171K |
| D0220 |
Intraoral - periapical first radiographic image |
10,058 |
9,739 |
$141K |
| D1206 |
Topical application of fluoride varnish |
6,694 |
6,583 |
$138K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,388 |
8,771 |
$133K |
| D0272 |
Bitewings - two radiographic images |
6,067 |
5,899 |
$132K |
| D1110 |
Prophylaxis - adult |
1,743 |
1,698 |
$86K |
| D0274 |
Bitewings - four radiographic images |
1,912 |
1,886 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,454 |
1,432 |
$61K |
| D2330 |
|
1,042 |
502 |
$61K |
| D0330 |
Panoramic radiographic image |
1,025 |
1,007 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,166 |
2,145 |
$45K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,049 |
1,037 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
802 |
776 |
$28K |
| D2932 |
|
112 |
27 |
$8K |
| D0707 |
|
29 |
29 |
$386.64 |
| D0602 |
|
2,989 |
2,834 |
$0.00 |
| D0601 |
|
460 |
433 |
$0.00 |
| D0603 |
|
1,313 |
1,193 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
53 |
50 |
$0.00 |