| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,285 |
3,211 |
$672K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,933 |
1,168 |
$579K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,594 |
2,643 |
$369K |
| D1120 |
Prophylaxis - child |
13,005 |
12,766 |
$352K |
| D1351 |
Sealant - per tooth |
11,045 |
3,216 |
$301K |
| D0120 |
Periodic oral evaluation - established patient |
11,086 |
10,958 |
$292K |
| D1206 |
Topical application of fluoride varnish |
15,112 |
14,847 |
$242K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,640 |
4,378 |
$203K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,929 |
3,762 |
$169K |
| D0220 |
Intraoral - periapical first radiographic image |
9,158 |
8,872 |
$137K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,040 |
1,050 |
$132K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,046 |
7,579 |
$116K |
| D0272 |
Bitewings - two radiographic images |
6,572 |
6,422 |
$114K |
| D0330 |
Panoramic radiographic image |
1,829 |
1,784 |
$87K |
| D9420 |
|
584 |
548 |
$68K |
| D1110 |
Prophylaxis - adult |
1,636 |
1,618 |
$62K |
| D2390 |
|
294 |
108 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,364 |
1,323 |
$51K |
| D0274 |
Bitewings - four radiographic images |
502 |
493 |
$15K |
| D1354 |
|
1,854 |
818 |
$13K |
| D2934 |
|
52 |
12 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
32 |
15 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
18 |
18 |
$621.90 |