| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,127 |
842 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,535 |
2,460 |
$70K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
825 |
294 |
$67K |
| D1120 |
Prophylaxis - child |
2,420 |
2,341 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
966 |
782 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,098 |
2,017 |
$49K |
| D1206 |
Topical application of fluoride varnish |
2,958 |
2,861 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
525 |
237 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
577 |
550 |
$25K |
| D1110 |
Prophylaxis - adult |
779 |
754 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,422 |
849 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
678 |
631 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,379 |
1,329 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
231 |
114 |
$13K |
| D0330 |
Panoramic radiographic image |
373 |
373 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
233 |
228 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
310 |
279 |
$7K |
| D1351 |
Sealant - per tooth |
235 |
97 |
$5K |
| D0272 |
Bitewings - two radiographic images |
343 |
335 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
150 |
141 |
$3K |
| D2330 |
|
62 |
42 |
$3K |
| D2331 |
|
31 |
24 |
$2K |
| D0240 |
|
43 |
43 |
$446.00 |
| D0170 |
|
12 |
12 |
$336.00 |
| D0273 |
|
15 |
15 |
$285.00 |