| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,583 |
2,902 |
$454K |
| D1120 |
Prophylaxis - child |
6,471 |
6,347 |
$353K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,080 |
1,058 |
$240K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,668 |
5,542 |
$165K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,868 |
1,512 |
$159K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,186 |
1,202 |
$140K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,293 |
3,048 |
$118K |
| D1206 |
Topical application of fluoride varnish |
5,217 |
5,108 |
$83K |
| D1351 |
Sealant - per tooth |
3,155 |
1,174 |
$69K |
| D0272 |
Bitewings - two radiographic images |
3,270 |
3,197 |
$64K |
| D0330 |
Panoramic radiographic image |
1,302 |
1,267 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
641 |
454 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,628 |
1,611 |
$41K |
| D2332 |
|
414 |
233 |
$34K |
| D1110 |
Prophylaxis - adult |
551 |
539 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
776 |
753 |
$27K |
| D2330 |
|
256 |
164 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,341 |
1,301 |
$14K |
| D0274 |
Bitewings - four radiographic images |
374 |
367 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
176 |
96 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,244 |
469 |
$7K |
| D2335 |
|
66 |
27 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
501 |
480 |
$4K |