| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,856 |
1,088 |
$111K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,564 |
846 |
$95K |
| D1110 |
Prophylaxis - adult |
1,360 |
1,343 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,583 |
2,553 |
$51K |
| D1120 |
Prophylaxis - child |
1,654 |
1,642 |
$42K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
404 |
182 |
$40K |
| D1206 |
Topical application of fluoride varnish |
2,303 |
2,278 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
506 |
343 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
329 |
229 |
$24K |
| D0330 |
Panoramic radiographic image |
393 |
386 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
602 |
592 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
229 |
128 |
$14K |
| D0272 |
Bitewings - two radiographic images |
984 |
975 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
206 |
115 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
312 |
300 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
127 |
116 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
904 |
873 |
$6K |
| D1351 |
Sealant - per tooth |
237 |
83 |
$5K |
| D0274 |
Bitewings - four radiographic images |
93 |
93 |
$2K |
| D2331 |
|
21 |
12 |
$1K |
| D2140 |
|
33 |
19 |
$1K |
| D2160 |
|
19 |
14 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
230 |
57 |
$1K |
| D2330 |
|
21 |
13 |
$994.41 |