| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,971 |
714 |
$274K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
545 |
247 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
590 |
287 |
$58K |
| D1120 |
Prophylaxis - child |
1,702 |
1,702 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
415 |
188 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,673 |
1,672 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,979 |
1,979 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
908 |
893 |
$28K |
| D9248 |
|
162 |
160 |
$22K |
| D0272 |
Bitewings - two radiographic images |
917 |
917 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
334 |
334 |
$13K |
| D0330 |
Panoramic radiographic image |
234 |
234 |
$12K |
| D1351 |
Sealant - per tooth |
213 |
75 |
$7K |
| D1110 |
Prophylaxis - adult |
146 |
146 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
65 |
28 |
$5K |
| D0274 |
Bitewings - four radiographic images |
110 |
110 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
82 |
$3K |
| D2330 |
|
18 |
12 |
$2K |