| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,306 |
551 |
$73K |
| D1110 |
Prophylaxis - adult |
1,549 |
1,542 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,486 |
2,480 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,438 |
1,432 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
855 |
777 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
569 |
294 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,617 |
1,617 |
$26K |
| D1120 |
Prophylaxis - child |
1,050 |
1,050 |
$26K |
| D0330 |
Panoramic radiographic image |
587 |
583 |
$21K |
| D9110 |
|
509 |
493 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
309 |
169 |
$15K |
| D0272 |
Bitewings - two radiographic images |
551 |
551 |
$9K |
| D0601 |
|
772 |
772 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
249 |
247 |
$5K |
| D2332 |
|
70 |
29 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
70 |
46 |
$4K |
| D1330 |
|
836 |
836 |
$4K |
| D1310 |
|
320 |
320 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
27 |
14 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
23 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
44 |
44 |
$752.12 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$102.68 |