| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,705 |
1,010 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,492 |
1,489 |
$97K |
| D1120 |
Prophylaxis - child |
1,932 |
1,928 |
$97K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
737 |
485 |
$87K |
| D1351 |
Sealant - per tooth |
2,170 |
742 |
$82K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,564 |
1,456 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,052 |
532 |
$56K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
523 |
372 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
646 |
483 |
$50K |
| D1206 |
Topical application of fluoride varnish |
1,888 |
1,884 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
635 |
426 |
$36K |
| D1310 |
|
742 |
740 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,310 |
1,513 |
$33K |
| D1510 |
|
135 |
131 |
$27K |
| D0350 |
|
2,148 |
1,024 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
296 |
296 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
387 |
386 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
347 |
347 |
$16K |
| D0272 |
Bitewings - two radiographic images |
936 |
932 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
309 |
309 |
$11K |
| D9430 |
|
291 |
269 |
$9K |
| D0330 |
Panoramic radiographic image |
309 |
309 |
$9K |
| D0603 |
|
480 |
478 |
$7K |
| D2330 |
|
85 |
55 |
$7K |
| D0274 |
Bitewings - four radiographic images |
293 |
293 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
429 |
405 |
$5K |
| D3240 |
|
49 |
31 |
$5K |
| D0601 |
|
234 |
234 |
$3K |
| D2331 |
|
42 |
35 |
$3K |