| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,285 |
748 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
3,737 |
3,694 |
$90K |
| D1120 |
Prophylaxis - child |
2,963 |
2,930 |
$75K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,488 |
1,458 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
762 |
539 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,203 |
3,173 |
$48K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
286 |
192 |
$39K |
| D1110 |
Prophylaxis - adult |
1,022 |
1,014 |
$37K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
445 |
244 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
370 |
221 |
$22K |
| D0330 |
Panoramic radiographic image |
390 |
389 |
$19K |
| D0272 |
Bitewings - two radiographic images |
999 |
990 |
$17K |
| D0274 |
Bitewings - four radiographic images |
486 |
483 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,199 |
384 |
$13K |
| D1206 |
Topical application of fluoride varnish |
764 |
753 |
$11K |
| D1351 |
Sealant - per tooth |
390 |
114 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
234 |
233 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
655 |
646 |
$9K |
| D2934 |
|
34 |
13 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
76 |
75 |
$3K |