| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,355 |
1,113 |
$180K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,633 |
394 |
$169K |
| D1120 |
Prophylaxis - child |
4,730 |
4,420 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,636 |
2,600 |
$84K |
| D1206 |
Topical application of fluoride varnish |
3,333 |
3,252 |
$67K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
432 |
295 |
$43K |
| D1351 |
Sealant - per tooth |
2,018 |
530 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,541 |
1,421 |
$41K |
| D2934 |
|
248 |
84 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,720 |
2,526 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,616 |
1,387 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
365 |
244 |
$24K |
| D0330 |
Panoramic radiographic image |
849 |
798 |
$19K |
| D9248 |
|
364 |
350 |
$16K |
| D0274 |
Bitewings - four radiographic images |
805 |
765 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
288 |
161 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
212 |
212 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,114 |
1,100 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,261 |
1,061 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
123 |
57 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
177 |
177 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
106 |
105 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
357 |
285 |
$3K |
| D2330 |
|
41 |
26 |
$3K |
| D0603 |
|
1,132 |
1,053 |
$0.00 |
| D0602 |
|
152 |
152 |
$0.00 |