| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,217 |
5,769 |
$871K |
| D0120 |
Periodic oral evaluation - established patient |
28,668 |
28,019 |
$737K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,901 |
6,140 |
$705K |
| D1120 |
Prophylaxis - child |
21,801 |
21,362 |
$590K |
| D1208 |
Topical application of fluoride, excluding varnish |
28,995 |
28,325 |
$475K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,328 |
6,965 |
$372K |
| D1110 |
Prophylaxis - adult |
9,014 |
8,733 |
$339K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,626 |
2,975 |
$294K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,875 |
1,338 |
$272K |
| D1351 |
Sealant - per tooth |
8,385 |
3,016 |
$232K |
| D0272 |
Bitewings - two radiographic images |
8,439 |
8,296 |
$155K |
| D0274 |
Bitewings - four radiographic images |
4,153 |
4,026 |
$130K |
| D0330 |
Panoramic radiographic image |
2,078 |
2,012 |
$112K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,218 |
894 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,160 |
2,095 |
$94K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
534 |
419 |
$72K |
| D0140 |
Limited oral evaluation - problem focused |
1,230 |
1,208 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
2,764 |
2,595 |
$41K |
| D1206 |
Topical application of fluoride varnish |
803 |
787 |
$13K |
| D0240 |
|
802 |
620 |
$13K |