| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,138 |
2,991 |
$359K |
| D1110 |
Prophylaxis - adult |
7,021 |
6,546 |
$279K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,881 |
1,033 |
$273K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,733 |
1,796 |
$260K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,200 |
1,537 |
$184K |
| D0120 |
Periodic oral evaluation - established patient |
9,485 |
8,920 |
$179K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,456 |
5,065 |
$170K |
| D1351 |
Sealant - per tooth |
7,569 |
1,360 |
$164K |
| D0274 |
Bitewings - four radiographic images |
5,297 |
4,896 |
$156K |
| D0140 |
Limited oral evaluation - problem focused |
4,413 |
4,066 |
$141K |
| D1206 |
Topical application of fluoride varnish |
7,460 |
7,012 |
$130K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,612 |
1,767 |
$129K |
| D0210 |
Intraoral - complete series of radiographic images |
3,756 |
2,675 |
$121K |
| D0330 |
Panoramic radiographic image |
2,398 |
2,189 |
$121K |
| D1120 |
Prophylaxis - child |
4,566 |
4,317 |
$119K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,324 |
2,050 |
$63K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,519 |
779 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
5,385 |
4,697 |
$53K |
| D0272 |
Bitewings - two radiographic images |
2,603 |
2,432 |
$49K |
| D2335 |
|
458 |
283 |
$47K |
| D4346 |
|
260 |
242 |
$45K |
| D2331 |
|
528 |
342 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
189 |
134 |
$30K |
| D1354 |
|
250 |
107 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,327 |
1,598 |
$19K |
| D2140 |
|
617 |
397 |
$16K |
| D4341 |
|
162 |
76 |
$14K |
| D2332 |
|
141 |
94 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
98 |
86 |
$9K |
| D2160 |
|
344 |
237 |
$8K |
| D2394 |
|
65 |
54 |
$7K |
| D2330 |
|
109 |
81 |
$5K |
| D2931 |
|
71 |
63 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
195 |
184 |
$2K |