| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,846 |
1,593 |
$155K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,031 |
836 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
5,313 |
5,156 |
$106K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,349 |
1,366 |
$97K |
| D1120 |
Prophylaxis - child |
4,667 |
4,518 |
$84K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,526 |
5,356 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,771 |
2,569 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,036 |
641 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,322 |
1,270 |
$44K |
| D0272 |
Bitewings - two radiographic images |
3,331 |
3,228 |
$41K |
| D1351 |
Sealant - per tooth |
2,524 |
755 |
$39K |
| D1110 |
Prophylaxis - adult |
1,364 |
1,321 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,549 |
2,119 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,432 |
1,394 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,945 |
2,825 |
$23K |
| D0330 |
Panoramic radiographic image |
777 |
775 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
817 |
747 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,136 |
1,095 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
129 |
71 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
218 |
217 |
$5K |
| D9420 |
|
53 |
43 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
178 |
173 |
$3K |
| D2332 |
|
71 |
16 |
$2K |
| D2330 |
|
20 |
12 |
$1K |