| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,024 |
1,528 |
$268K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,722 |
664 |
$202K |
| D0120 |
Periodic oral evaluation - established patient |
4,572 |
4,571 |
$189K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,455 |
1,348 |
$185K |
| D1120 |
Prophylaxis - child |
5,319 |
5,297 |
$155K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,357 |
1,078 |
$134K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,335 |
540 |
$131K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,163 |
6,015 |
$124K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,168 |
2,124 |
$82K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
830 |
446 |
$66K |
| D2330 |
|
870 |
393 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
891 |
889 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,325 |
5,304 |
$54K |
| D0272 |
Bitewings - two radiographic images |
4,591 |
4,583 |
$53K |
| D1351 |
Sealant - per tooth |
2,338 |
753 |
$50K |
| D0350 |
|
3,060 |
1,720 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,073 |
2,045 |
$24K |
| D2932 |
|
212 |
90 |
$22K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
25 |
15 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
116 |
115 |
$6K |
| D9430 |
|
196 |
191 |
$6K |
| D9222 |
|
15 |
15 |
$2K |
| D9610 |
|
16 |
16 |
$1K |