| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,933 |
1,624 |
$301K |
| D1120 |
Prophylaxis - child |
6,203 |
6,203 |
$169K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
515 |
515 |
$163K |
| D0120 |
Periodic oral evaluation - established patient |
8,074 |
8,074 |
$150K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,138 |
568 |
$134K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,902 |
1,028 |
$122K |
| D1206 |
Topical application of fluoride varnish |
7,980 |
7,980 |
$121K |
| D9248 |
|
966 |
933 |
$119K |
| D1110 |
Prophylaxis - adult |
2,420 |
2,420 |
$97K |
| D1351 |
Sealant - per tooth |
2,841 |
833 |
$62K |
| D0330 |
Panoramic radiographic image |
1,402 |
1,402 |
$60K |
| D0272 |
Bitewings - two radiographic images |
3,605 |
3,605 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,316 |
2,189 |
$57K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
606 |
332 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
788 |
537 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,487 |
2,446 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,171 |
1,163 |
$32K |
| D0603 |
|
2,216 |
2,216 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
558 |
558 |
$16K |
| D0601 |
|
1,354 |
1,354 |
$11K |
| D0274 |
Bitewings - four radiographic images |
419 |
419 |
$10K |
| D0602 |
|
1,124 |
1,124 |
$9K |
| D9310 |
|
183 |
183 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
285 |
285 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
814 |
754 |
$6K |
| D2332 |
|
37 |
27 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$2K |