| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,125 |
2,417 |
$327K |
| D1120 |
Prophylaxis - child |
10,505 |
10,505 |
$303K |
| D0120 |
Periodic oral evaluation - established patient |
10,233 |
10,233 |
$286K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,595 |
3,437 |
$205K |
| D1206 |
Topical application of fluoride varnish |
9,038 |
9,038 |
$137K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,544 |
584 |
$125K |
| D0274 |
Bitewings - four radiographic images |
2,991 |
2,991 |
$93K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,177 |
769 |
$90K |
| D1351 |
Sealant - per tooth |
2,869 |
1,148 |
$81K |
| D0330 |
Panoramic radiographic image |
1,421 |
1,421 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,348 |
726 |
$70K |
| D0272 |
Bitewings - two radiographic images |
3,487 |
3,487 |
$67K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
613 |
227 |
$41K |
| D2332 |
|
307 |
172 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
611 |
404 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,096 |
2,087 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,079 |
2,079 |
$24K |
| D7111 |
|
348 |
227 |
$18K |
| D1110 |
Prophylaxis - adult |
466 |
466 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
582 |
577 |
$17K |
| D1354 |
|
2,179 |
591 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,383 |
476 |
$12K |
| D2331 |
|
134 |
87 |
$8K |
| D0240 |
|
374 |
374 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
242 |
242 |
$7K |
| D2335 |
|
76 |
39 |
$7K |
| D2330 |
|
62 |
37 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
84 |
84 |
$2K |