| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,079 |
619 |
$95K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
670 |
270 |
$80K |
| D1351 |
Sealant - per tooth |
2,524 |
537 |
$60K |
| D1120 |
Prophylaxis - child |
2,545 |
2,380 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,280 |
2,153 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,258 |
1,124 |
$43K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
629 |
293 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
546 |
338 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,778 |
2,594 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
658 |
593 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
343 |
208 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,209 |
1,122 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
125 |
97 |
$14K |
| D9420 |
|
120 |
111 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
368 |
341 |
$11K |
| D1510 |
|
131 |
59 |
$11K |
| D0330 |
Panoramic radiographic image |
238 |
219 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
514 |
458 |
$6K |
| D2330 |
|
101 |
58 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
37 |
15 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
335 |
226 |
$4K |
| D1110 |
Prophylaxis - adult |
49 |
44 |
$2K |
| D2331 |
|
15 |
12 |
$1K |