| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,853 |
1,063 |
$152K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,293 |
1,292 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,074 |
564 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
1,582 |
1,581 |
$62K |
| D1120 |
Prophylaxis - child |
1,980 |
1,978 |
$58K |
| D1110 |
Prophylaxis - adult |
600 |
600 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,648 |
2,871 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,930 |
1,925 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
399 |
201 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,545 |
2,543 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
450 |
251 |
$25K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
131 |
77 |
$16K |
| D9993 |
|
253 |
253 |
$15K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
143 |
84 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
112 |
59 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
313 |
284 |
$12K |
| D1310 |
|
253 |
253 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
219 |
219 |
$10K |
| D2160 |
|
111 |
71 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
620 |
590 |
$7K |
| D0350 |
|
671 |
312 |
$6K |
| D2330 |
|
78 |
58 |
$6K |
| D1351 |
Sealant - per tooth |
243 |
86 |
$5K |
| D2140 |
|
54 |
38 |
$3K |
| D0603 |
|
207 |
207 |
$3K |
| D4341 |
|
54 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
200 |
200 |
$2K |
| D1510 |
|
13 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
20 |
20 |
$1K |
| D1206 |
Topical application of fluoride varnish |
54 |
53 |
$564.00 |
| D0602 |
|
29 |
29 |
$420.00 |