| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,818 |
1,466 |
$267K |
| D1120 |
Prophylaxis - child |
5,774 |
5,686 |
$218K |
| D0120 |
Periodic oral evaluation - established patient |
7,101 |
6,996 |
$202K |
| D1206 |
Topical application of fluoride varnish |
8,476 |
8,339 |
$161K |
| D1110 |
Prophylaxis - adult |
2,363 |
2,326 |
$127K |
| D0272 |
Bitewings - two radiographic images |
4,698 |
4,616 |
$110K |
| D1351 |
Sealant - per tooth |
5,560 |
1,323 |
$105K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,216 |
3,018 |
$96K |
| D7140 |
Extraction, erupted tooth or exposed root |
926 |
460 |
$89K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
384 |
197 |
$47K |
| D9310 |
|
760 |
747 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
467 |
329 |
$32K |
| D0330 |
Panoramic radiographic image |
297 |
292 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
95 |
60 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
324 |
310 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
477 |
447 |
$6K |
| D3120 |
|
82 |
58 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
21 |
21 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
24 |
$570.00 |