| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,769 |
3,776 |
$584K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,585 |
2,121 |
$567K |
| D1120 |
Prophylaxis - child |
15,308 |
15,308 |
$530K |
| D9248 |
|
6,649 |
6,560 |
$435K |
| D0120 |
Periodic oral evaluation - established patient |
18,816 |
18,816 |
$430K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,946 |
11,760 |
$378K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,594 |
1,959 |
$370K |
| D1206 |
Topical application of fluoride varnish |
21,883 |
21,883 |
$354K |
| D1110 |
Prophylaxis - adult |
6,527 |
6,527 |
$323K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,603 |
2,529 |
$277K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,088 |
2,034 |
$256K |
| D0272 |
Bitewings - two radiographic images |
12,837 |
12,837 |
$241K |
| D2934 |
|
1,384 |
536 |
$173K |
| D0274 |
Bitewings - four radiographic images |
6,109 |
6,109 |
$166K |
| D0330 |
Panoramic radiographic image |
2,497 |
2,497 |
$122K |
| D0220 |
Intraoral - periapical first radiographic image |
8,394 |
8,349 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,636 |
2,636 |
$106K |
| D1351 |
Sealant - per tooth |
2,356 |
683 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
1,809 |
1,799 |
$69K |
| D0145 |
Oral evaluation for a patient under three years of age |
897 |
897 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
255 |
211 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,534 |
2,516 |
$27K |
| D1510 |
|
111 |
105 |
$19K |
| D2330 |
|
40 |
29 |
$3K |