| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,733 |
1,112 |
$248K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,378 |
2,378 |
$168K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,281 |
1,923 |
$117K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
409 |
335 |
$78K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
336 |
269 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
562 |
359 |
$62K |
| D9920 |
|
286 |
263 |
$57K |
| D1120 |
Prophylaxis - child |
1,420 |
1,418 |
$56K |
| D0272 |
Bitewings - two radiographic images |
1,553 |
1,553 |
$46K |
| D1351 |
Sealant - per tooth |
852 |
299 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
285 |
194 |
$33K |
| D0330 |
Panoramic radiographic image |
528 |
527 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,292 |
1,290 |
$31K |
| D0274 |
Bitewings - four radiographic images |
221 |
221 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
250 |
247 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
31 |
24 |
$5K |
| D1110 |
Prophylaxis - adult |
48 |
47 |
$3K |
| D1206 |
Topical application of fluoride varnish |
50 |
48 |
$1K |
| D0240 |
|
26 |
13 |
$843.60 |