| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,268 |
761 |
$83K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
809 |
284 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,070 |
2,019 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
909 |
548 |
$46K |
| D1120 |
Prophylaxis - child |
1,942 |
1,905 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,248 |
2,206 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,235 |
1,112 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
672 |
659 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,353 |
1,335 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
367 |
235 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,356 |
875 |
$15K |
| D1110 |
Prophylaxis - adult |
538 |
520 |
$15K |
| D0274 |
Bitewings - four radiographic images |
608 |
589 |
$13K |
| D1351 |
Sealant - per tooth |
635 |
205 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
120 |
94 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,147 |
1,098 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
366 |
329 |
$8K |
| D0330 |
Panoramic radiographic image |
242 |
242 |
$7K |
| D1206 |
Topical application of fluoride varnish |
474 |
456 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
123 |
47 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
93 |
93 |
$3K |
| D9420 |
|
36 |
29 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
106 |
106 |
$2K |