| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,874 |
3,556 |
$611K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,461 |
2,992 |
$569K |
| D0120 |
Periodic oral evaluation - established patient |
20,047 |
19,562 |
$526K |
| D1120 |
Prophylaxis - child |
18,049 |
17,650 |
$498K |
| D1351 |
Sealant - per tooth |
16,260 |
4,159 |
$457K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,660 |
22,114 |
$381K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,253 |
6,795 |
$320K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,415 |
2,080 |
$218K |
| D1110 |
Prophylaxis - adult |
4,854 |
4,766 |
$189K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,325 |
3,208 |
$146K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,008 |
706 |
$143K |
| D0272 |
Bitewings - two radiographic images |
7,091 |
6,941 |
$130K |
| D0330 |
Panoramic radiographic image |
2,070 |
2,037 |
$121K |
| D0220 |
Intraoral - periapical first radiographic image |
5,223 |
5,029 |
$79K |
| D0274 |
Bitewings - four radiographic images |
2,210 |
2,170 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
1,685 |
1,606 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,481 |
2,198 |
$54K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
289 |
220 |
$22K |
| D2330 |
|
158 |
96 |
$9K |