| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,704 |
1,354 |
$519K |
| D9248 |
|
1,959 |
1,378 |
$266K |
| D1120 |
Prophylaxis - child |
4,053 |
3,764 |
$231K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,165 |
547 |
$215K |
| D0120 |
Periodic oral evaluation - established patient |
4,611 |
4,247 |
$192K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,626 |
583 |
$157K |
| D0272 |
Bitewings - two radiographic images |
3,897 |
3,585 |
$139K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,375 |
2,351 |
$138K |
| D1206 |
Topical application of fluoride varnish |
5,584 |
5,076 |
$138K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,122 |
4,627 |
$96K |
| D1110 |
Prophylaxis - adult |
1,186 |
1,030 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
3,695 |
3,359 |
$78K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
435 |
189 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
1,219 |
1,060 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,080 |
977 |
$55K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
446 |
183 |
$48K |
| D0240 |
|
1,704 |
1,536 |
$43K |
| D9610 |
|
516 |
429 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
595 |
534 |
$34K |
| D7960 |
|
56 |
40 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
53 |
48 |
$3K |
| D1999 |
|
54 |
46 |
$0.00 |
| D3120 |
|
16 |
13 |
$0.00 |