| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,163 |
1,376 |
$233K |
| D1351 |
Sealant - per tooth |
10,903 |
2,030 |
$231K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,943 |
1,778 |
$217K |
| D1120 |
Prophylaxis - child |
7,332 |
6,833 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
8,077 |
7,526 |
$182K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
861 |
447 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,818 |
7,274 |
$90K |
| D1110 |
Prophylaxis - adult |
1,993 |
1,835 |
$83K |
| D0272 |
Bitewings - two radiographic images |
4,382 |
4,045 |
$80K |
| D9248 |
|
913 |
815 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
7,381 |
6,711 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,826 |
5,812 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
985 |
609 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,193 |
1,112 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
823 |
467 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,638 |
1,407 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,116 |
1,031 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,368 |
1,201 |
$19K |
| D1206 |
Topical application of fluoride varnish |
1,416 |
1,301 |
$16K |
| D0330 |
Panoramic radiographic image |
316 |
306 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
91 |
42 |
$6K |
| D0602 |
|
5,748 |
5,161 |
$0.00 |
| D0601 |
|
3,527 |
3,471 |
$0.00 |
| D0603 |
|
1,742 |
1,614 |
$0.00 |