| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,740 |
4,432 |
$653K |
| D1120 |
Prophylaxis - child |
13,098 |
12,771 |
$351K |
| D1351 |
Sealant - per tooth |
17,443 |
4,149 |
$342K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,275 |
3,425 |
$293K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,235 |
1,027 |
$246K |
| D0120 |
Periodic oral evaluation - established patient |
11,527 |
11,237 |
$238K |
| D1110 |
Prophylaxis - adult |
4,649 |
4,488 |
$186K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,544 |
6,303 |
$178K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,539 |
14,200 |
$171K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,037 |
1,977 |
$165K |
| D0220 |
Intraoral - periapical first radiographic image |
14,558 |
13,992 |
$156K |
| D0330 |
Panoramic radiographic image |
5,109 |
4,963 |
$129K |
| D0272 |
Bitewings - two radiographic images |
8,181 |
7,974 |
$121K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,387 |
4,983 |
$117K |
| D0274 |
Bitewings - four radiographic images |
4,928 |
4,775 |
$105K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,621 |
867 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,376 |
11,878 |
$94K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
720 |
498 |
$86K |
| D0210 |
Intraoral - complete series of radiographic images |
1,155 |
1,109 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
2,122 |
1,999 |
$51K |
| D7240 |
Removal of impacted tooth - completely bony |
181 |
65 |
$37K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
420 |
110 |
$31K |
| D1206 |
Topical application of fluoride varnish |
2,066 |
2,003 |
$28K |
| D2332 |
|
205 |
147 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
83 |
42 |
$11K |
| D2335 |
|
48 |
26 |
$5K |
| D2330 |
|
71 |
51 |
$4K |
| D0350 |
|
123 |
123 |
$2K |
| D7111 |
|
53 |
39 |
$1K |
| D0270 |
|
55 |
54 |
$357.11 |
| D0603 |
|
8,511 |
8,378 |
$63.39 |
| D0602 |
|
3,374 |
3,308 |
$9.02 |
| D0601 |
|
641 |
620 |
$0.00 |
| D1999 |
|
327 |
280 |
$0.00 |