| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,409 |
1,370 |
$434K |
| D1120 |
Prophylaxis - child |
5,819 |
5,540 |
$185K |
| D0120 |
Periodic oral evaluation - established patient |
5,588 |
5,318 |
$145K |
| D1206 |
Topical application of fluoride varnish |
4,596 |
4,337 |
$100K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,357 |
760 |
$98K |
| D1351 |
Sealant - per tooth |
3,092 |
929 |
$82K |
| D0272 |
Bitewings - two radiographic images |
3,444 |
3,265 |
$80K |
| D9248 |
|
533 |
493 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,418 |
2,187 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
563 |
255 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
270 |
111 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,921 |
1,851 |
$35K |
| D1110 |
Prophylaxis - adult |
788 |
738 |
$34K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
245 |
102 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
420 |
396 |
$16K |
| D0330 |
Panoramic radiographic image |
204 |
195 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
330 |
311 |
$12K |
| D0240 |
|
659 |
334 |
$8K |
| D0274 |
Bitewings - four radiographic images |
66 |
60 |
$3K |
| D1310 |
|
54 |
54 |
$2K |