| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,757 |
1,406 |
$481K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,309 |
295 |
$189K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,135 |
840 |
$163K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,963 |
3,072 |
$89K |
| D1120 |
Prophylaxis - child |
2,155 |
2,130 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,911 |
1,884 |
$65K |
| D0145 |
Oral evaluation for a patient under three years of age |
370 |
366 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,484 |
1,466 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,739 |
1,698 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,124 |
3,089 |
$45K |
| D1110 |
Prophylaxis - adult |
848 |
837 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,200 |
3,147 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,118 |
1,105 |
$32K |
| D1351 |
Sealant - per tooth |
998 |
306 |
$27K |
| D0350 |
|
1,650 |
1,615 |
$27K |
| D0272 |
Bitewings - two radiographic images |
863 |
859 |
$20K |
| D9248 |
|
71 |
71 |
$8K |
| D2330 |
|
75 |
39 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
22 |
12 |
$2K |
| D0170 |
|
12 |
12 |
$82.70 |
| D0603 |
|
3,634 |
3,581 |
$0.00 |