| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
6,532 |
1,294 |
$230K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
885 |
618 |
$76K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
621 |
350 |
$63K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
474 |
334 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,442 |
1,269 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,151 |
1,056 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
548 |
354 |
$32K |
| D0330 |
Panoramic radiographic image |
669 |
621 |
$31K |
| D1120 |
Prophylaxis - child |
1,093 |
1,015 |
$29K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
387 |
262 |
$26K |
| D1206 |
Topical application of fluoride varnish |
803 |
758 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,168 |
1,081 |
$16K |
| D1351 |
Sealant - per tooth |
539 |
177 |
$14K |
| D1110 |
Prophylaxis - adult |
338 |
326 |
$13K |
| D0272 |
Bitewings - two radiographic images |
694 |
621 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
277 |
259 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
347 |
331 |
$7K |
| D0274 |
Bitewings - four radiographic images |
272 |
258 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
554 |
511 |
$6K |
| D3230 |
|
32 |
13 |
$4K |
| D2335 |
|
43 |
27 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
330 |
205 |
$3K |
| D3120 |
|
111 |
94 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
121 |
116 |
$3K |
| D0240 |
|
99 |
78 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
15 |
$1K |