| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,628 |
2,916 |
$491K |
| D0120 |
Periodic oral evaluation - established patient |
11,707 |
10,618 |
$320K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,170 |
5,304 |
$291K |
| D1120 |
Prophylaxis - child |
8,051 |
7,292 |
$231K |
| D1206 |
Topical application of fluoride varnish |
12,773 |
11,566 |
$215K |
| D1351 |
Sealant - per tooth |
6,997 |
1,985 |
$205K |
| D1110 |
Prophylaxis - adult |
4,378 |
3,982 |
$181K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,252 |
1,636 |
$179K |
| 99199 |
Unlisted special service, procedure or report |
20,097 |
19,734 |
$96K |
| D0330 |
Panoramic radiographic image |
1,520 |
1,348 |
$88K |
| D0272 |
Bitewings - two radiographic images |
3,658 |
3,311 |
$71K |
| D0274 |
Bitewings - four radiographic images |
2,029 |
1,847 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
949 |
789 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
889 |
743 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
256 |
250 |
$12K |
| D0240 |
|
490 |
249 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
43 |
40 |
$7K |
| D7111 |
|
66 |
52 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
12 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
13 |
13 |
$1K |
| D1354 |
|
45 |
18 |
$311.76 |
| D1330 |
|
10,790 |
9,634 |
$0.00 |
| D1310 |
|
10,791 |
9,634 |
$0.00 |