| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,240 |
3,398 |
$603K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,831 |
2,234 |
$468K |
| D1351 |
Sealant - per tooth |
10,371 |
1,823 |
$284K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,430 |
7,553 |
$240K |
| D1120 |
Prophylaxis - child |
7,273 |
6,633 |
$233K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,031 |
11,899 |
$226K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,723 |
1,008 |
$221K |
| D1110 |
Prophylaxis - adult |
5,122 |
4,694 |
$175K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,462 |
1,333 |
$152K |
| D0120 |
Periodic oral evaluation - established patient |
6,610 |
6,183 |
$150K |
| D0274 |
Bitewings - four radiographic images |
5,723 |
5,346 |
$141K |
| D0220 |
Intraoral - periapical first radiographic image |
10,874 |
9,906 |
$137K |
| D0210 |
Intraoral - complete series of radiographic images |
3,143 |
2,815 |
$134K |
| D0140 |
Limited oral evaluation - problem focused |
2,897 |
2,663 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,649 |
8,347 |
$93K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
748 |
497 |
$82K |
| D0272 |
Bitewings - two radiographic images |
3,052 |
2,760 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,896 |
1,604 |
$64K |
| D0330 |
Panoramic radiographic image |
920 |
855 |
$54K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
77 |
52 |
$12K |
| D4355 |
|
85 |
79 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
62 |
44 |
$6K |
| D4341 |
|
67 |
25 |
$4K |
| D9110 |
|
61 |
52 |
$3K |
| D2330 |
|
25 |
15 |
$1K |