| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,144 |
1,065 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
5,043 |
4,901 |
$108K |
| D1120 |
Prophylaxis - child |
4,339 |
4,207 |
$84K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,831 |
5,616 |
$83K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
698 |
319 |
$81K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
790 |
463 |
$56K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
737 |
319 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
923 |
515 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
800 |
467 |
$39K |
| D0272 |
Bitewings - two radiographic images |
4,072 |
3,958 |
$39K |
| D1110 |
Prophylaxis - adult |
1,032 |
994 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,537 |
1,457 |
$30K |
| D9999 |
Unspecified adjunctive procedure, by report |
990 |
957 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
655 |
616 |
$22K |
| D0330 |
Panoramic radiographic image |
486 |
473 |
$18K |
| D1351 |
Sealant - per tooth |
571 |
201 |
$11K |
| D2332 |
|
118 |
67 |
$9K |
| D2330 |
|
97 |
47 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
264 |
256 |
$5K |
| D9920 |
|
161 |
157 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
202 |
193 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
561 |
181 |
$1K |