| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,551 |
2,622 |
$551K |
| D1351 |
Sealant - per tooth |
14,211 |
3,615 |
$392K |
| D1120 |
Prophylaxis - child |
5,682 |
5,644 |
$198K |
| D0120 |
Periodic oral evaluation - established patient |
7,085 |
7,052 |
$196K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,282 |
684 |
$184K |
| D1110 |
Prophylaxis - adult |
3,342 |
3,332 |
$176K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,165 |
1,157 |
$162K |
| D0210 |
Intraoral - complete series of radiographic images |
2,211 |
2,202 |
$148K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,815 |
1,246 |
$140K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,948 |
7,912 |
$114K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,081 |
688 |
$112K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,997 |
3,794 |
$105K |
| D0274 |
Bitewings - four radiographic images |
3,015 |
3,005 |
$100K |
| D0220 |
Intraoral - periapical first radiographic image |
7,072 |
7,020 |
$85K |
| D0272 |
Bitewings - two radiographic images |
3,698 |
3,674 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,776 |
6,706 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,929 |
1,918 |
$65K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
566 |
320 |
$45K |
| D1206 |
Topical application of fluoride varnish |
1,051 |
1,048 |
$14K |
| D2332 |
|
110 |
72 |
$13K |
| D7111 |
|
422 |
265 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
231 |
231 |
$4K |
| D1330 |
|
264 |
259 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
13 |
$960.90 |
| D0602 |
|
2,893 |
2,875 |
$0.00 |
| D0603 |
|
7,275 |
7,225 |
$0.00 |