| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,858 |
1,598 |
$374K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,638 |
2,618 |
$368K |
| D0120 |
Periodic oral evaluation - established patient |
11,051 |
10,952 |
$311K |
| D1120 |
Prophylaxis - child |
8,179 |
8,099 |
$291K |
| D1351 |
Sealant - per tooth |
8,111 |
1,881 |
$216K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,199 |
436 |
$173K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,591 |
11,460 |
$165K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,193 |
1,253 |
$165K |
| D1110 |
Prophylaxis - adult |
2,951 |
2,923 |
$158K |
| D0272 |
Bitewings - two radiographic images |
5,957 |
5,899 |
$129K |
| D0220 |
Intraoral - periapical first radiographic image |
10,206 |
10,064 |
$116K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,752 |
8,456 |
$97K |
| D0274 |
Bitewings - four radiographic images |
2,452 |
2,425 |
$80K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,003 |
2,875 |
$79K |
| D0210 |
Intraoral - complete series of radiographic images |
766 |
757 |
$48K |
| D0330 |
Panoramic radiographic image |
1,428 |
1,408 |
$43K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
287 |
126 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
199 |
102 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
557 |
542 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
257 |
255 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
51 |
39 |
$3K |
| D7111 |
|
37 |
26 |
$400.56 |
| D0270 |
|
24 |
24 |
$117.60 |
| D0602 |
|
4,758 |
4,719 |
$0.00 |
| D0603 |
|
9,541 |
9,439 |
$0.00 |
| D0601 |
|
134 |
130 |
$0.00 |