| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,875 |
967 |
$376K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,794 |
1,764 |
$246K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,320 |
247 |
$182K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,107 |
554 |
$156K |
| D1120 |
Prophylaxis - child |
2,540 |
2,500 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,170 |
2,135 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,502 |
3,145 |
$59K |
| D1110 |
Prophylaxis - adult |
1,133 |
1,105 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,666 |
1,626 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,550 |
3,488 |
$49K |
| D0272 |
Bitewings - two radiographic images |
2,324 |
2,291 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,661 |
3,388 |
$41K |
| D1351 |
Sealant - per tooth |
1,499 |
295 |
$36K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
343 |
90 |
$27K |
| D9248 |
|
274 |
269 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
972 |
931 |
$25K |
| D0274 |
Bitewings - four radiographic images |
618 |
604 |
$20K |
| D0330 |
Panoramic radiographic image |
403 |
394 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
310 |
299 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
67 |
67 |
$4K |
| D1206 |
Topical application of fluoride varnish |
104 |
102 |
$1K |
| D0603 |
|
5,647 |
5,539 |
$0.00 |