| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,469 |
1,654 |
$478K |
| D0120 |
Periodic oral evaluation - established patient |
7,127 |
7,094 |
$158K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,428 |
749 |
$152K |
| D1120 |
Prophylaxis - child |
4,810 |
4,790 |
$146K |
| D1206 |
Topical application of fluoride varnish |
8,043 |
8,005 |
$135K |
| D1351 |
Sealant - per tooth |
3,697 |
1,005 |
$124K |
| D1110 |
Prophylaxis - adult |
2,629 |
2,615 |
$107K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
612 |
402 |
$100K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,819 |
1,733 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
4,096 |
4,063 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
495 |
293 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,249 |
2,235 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,026 |
2,996 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,224 |
1,214 |
$35K |
| D0330 |
Panoramic radiographic image |
673 |
668 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
611 |
600 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
139 |
81 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
510 |
507 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
348 |
347 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
266 |
262 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
85 |
43 |
$7K |