| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,886 |
3,437 |
$292K |
| D1120 |
Prophylaxis - child |
10,589 |
10,051 |
$264K |
| D0120 |
Periodic oral evaluation - established patient |
13,300 |
12,629 |
$213K |
| D0272 |
Bitewings - two radiographic images |
8,622 |
8,146 |
$116K |
| D1110 |
Prophylaxis - adult |
3,980 |
3,764 |
$108K |
| D1206 |
Topical application of fluoride varnish |
9,459 |
9,074 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,352 |
1,548 |
$103K |
| D0274 |
Bitewings - four radiographic images |
5,503 |
5,221 |
$93K |
| D0140 |
Limited oral evaluation - problem focused |
3,674 |
3,359 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,955 |
3,629 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,076 |
608 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,721 |
2,390 |
$39K |
| D0330 |
Panoramic radiographic image |
1,534 |
1,503 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
3,518 |
3,197 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,045 |
996 |
$26K |
| D0145 |
Oral evaluation for a patient under three years of age |
947 |
902 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
304 |
131 |
$16K |
| D1351 |
Sealant - per tooth |
1,018 |
265 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
128 |
61 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
172 |
138 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
100 |
100 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
643 |
462 |
$6K |
| D0240 |
|
123 |
54 |
$854.83 |
| D9248 |
|
12 |
12 |
$369.00 |