| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,950 |
3,336 |
$481K |
| D0120 |
Periodic oral evaluation - established patient |
15,999 |
14,660 |
$386K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,673 |
3,125 |
$344K |
| D1120 |
Prophylaxis - child |
12,125 |
11,215 |
$310K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,212 |
13,915 |
$233K |
| D1110 |
Prophylaxis - adult |
4,865 |
4,319 |
$167K |
| D1351 |
Sealant - per tooth |
5,751 |
1,843 |
$153K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,764 |
2,365 |
$114K |
| D0330 |
Panoramic radiographic image |
2,474 |
1,919 |
$109K |
| D0272 |
Bitewings - two radiographic images |
5,230 |
4,727 |
$89K |
| D0274 |
Bitewings - four radiographic images |
2,374 |
2,028 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
578 |
368 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
534 |
470 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,178 |
1,073 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
90 |
67 |
$13K |
| D1206 |
Topical application of fluoride varnish |
858 |
795 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
218 |
211 |
$8K |
| D0240 |
|
484 |
279 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
50 |
42 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
29 |
24 |
$2K |