| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
610 |
398 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,029 |
1,028 |
$35K |
| D1120 |
Prophylaxis - child |
1,038 |
1,037 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,518 |
1,515 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
442 |
281 |
$24K |
| D0274 |
Bitewings - four radiographic images |
663 |
660 |
$19K |
| D1110 |
Prophylaxis - adult |
406 |
404 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,428 |
1,422 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
485 |
444 |
$13K |
| D4346 |
|
106 |
106 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,349 |
1,333 |
$12K |
| D0272 |
Bitewings - two radiographic images |
590 |
590 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
512 |
512 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
154 |
87 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
109 |
80 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
68 |
54 |
$8K |
| D2335 |
|
55 |
32 |
$7K |
| D1351 |
Sealant - per tooth |
157 |
63 |
$4K |
| D0330 |
Panoramic radiographic image |
64 |
64 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
42 |
34 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
13 |
$3K |
| D2331 |
|
29 |
22 |
$2K |
| D2332 |
|
22 |
16 |
$2K |
| D2330 |
|
34 |
24 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
38 |
$2K |
| D9110 |
|
39 |
39 |
$2K |
| D0240 |
|
65 |
65 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
41 |
$1K |
| D0270 |
|
18 |
17 |
$176.76 |