| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,432 |
2,367 |
$333K |
| D1110 |
Prophylaxis - adult |
6,541 |
6,541 |
$328K |
| D0120 |
Periodic oral evaluation - established patient |
12,339 |
12,339 |
$283K |
| D1120 |
Prophylaxis - child |
8,089 |
8,089 |
$281K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,477 |
13,477 |
$220K |
| D0272 |
Bitewings - two radiographic images |
8,564 |
8,564 |
$161K |
| D0330 |
Panoramic radiographic image |
2,453 |
2,453 |
$121K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,638 |
3,559 |
$115K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,406 |
1,146 |
$111K |
| D0274 |
Bitewings - four radiographic images |
3,628 |
3,628 |
$99K |
| D9248 |
|
1,268 |
1,217 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,255 |
1,255 |
$50K |
| D1351 |
Sealant - per tooth |
1,478 |
471 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
346 |
281 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,675 |
2,666 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
877 |
874 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
179 |
122 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
68 |
55 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
216 |
216 |
$8K |
| D0240 |
|
336 |
180 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
13 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
29 |
26 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
183 |
157 |
$2K |