| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,550 |
773 |
$122K |
| D1351 |
Sealant - per tooth |
3,983 |
707 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,337 |
2,047 |
$91K |
| D1120 |
Prophylaxis - child |
2,598 |
2,351 |
$89K |
| D1110 |
Prophylaxis - adult |
1,633 |
1,475 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,310 |
681 |
$77K |
| D0210 |
Intraoral - complete series of radiographic images |
2,417 |
1,333 |
$76K |
| D1206 |
Topical application of fluoride varnish |
3,130 |
2,889 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,829 |
2,546 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
505 |
314 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
310 |
131 |
$46K |
| D0274 |
Bitewings - four radiographic images |
949 |
851 |
$30K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
219 |
110 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,222 |
1,125 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
382 |
163 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,869 |
1,679 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
621 |
542 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,411 |
1,143 |
$14K |
| D0330 |
Panoramic radiographic image |
422 |
382 |
$13K |
| D4342 |
|
309 |
62 |
$10K |
| D4346 |
|
68 |
64 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
431 |
306 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
305 |
261 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
120 |
112 |
$4K |
| D2330 |
|
38 |
26 |
$3K |
| D2332 |
|
20 |
12 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
24 |
16 |
$2K |
| D4910 |
|
14 |
12 |
$1K |
| D9920 |
|
13 |
13 |
$513.32 |
| D1999 |
|
63 |
16 |
$0.00 |