| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,691 |
1,629 |
$247K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,091 |
1,508 |
$176K |
| D1120 |
Prophylaxis - child |
3,275 |
3,273 |
$166K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,277 |
715 |
$161K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,229 |
690 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
2,988 |
2,988 |
$99K |
| D1351 |
Sealant - per tooth |
1,454 |
602 |
$67K |
| D1206 |
Topical application of fluoride varnish |
1,859 |
1,858 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,417 |
1,417 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,301 |
1,301 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
316 |
241 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
186 |
183 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
47 |
44 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
27 |
27 |
$711.20 |
| D0140 |
Limited oral evaluation - problem focused |
40 |
40 |
$645.02 |
| D9990 |
|
30 |
28 |
$330.00 |