| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,451 |
2,415 |
$606K |
| D1120 |
Prophylaxis - child |
11,748 |
11,742 |
$366K |
| D0120 |
Periodic oral evaluation - established patient |
15,887 |
15,870 |
$361K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,740 |
1,005 |
$341K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,021 |
1,648 |
$302K |
| D1110 |
Prophylaxis - adult |
6,369 |
6,357 |
$269K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,201 |
1,323 |
$233K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,823 |
14,564 |
$213K |
| D0220 |
Intraoral - periapical first radiographic image |
15,104 |
15,048 |
$188K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,547 |
13,465 |
$160K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,675 |
697 |
$144K |
| D0272 |
Bitewings - two radiographic images |
6,985 |
6,981 |
$144K |
| D1351 |
Sealant - per tooth |
4,016 |
1,195 |
$137K |
| D0274 |
Bitewings - four radiographic images |
3,859 |
3,857 |
$114K |
| D1206 |
Topical application of fluoride varnish |
4,351 |
4,348 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,278 |
2,145 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
2,003 |
1,988 |
$63K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,460 |
1,460 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,339 |
1,321 |
$45K |
| D0330 |
Panoramic radiographic image |
462 |
462 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
612 |
612 |
$24K |
| D7230 |
|
30 |
16 |
$7K |