| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,157 |
1,266 |
$214K |
| D1120 |
Prophylaxis - child |
3,405 |
3,266 |
$108K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
981 |
440 |
$98K |
| D1206 |
Topical application of fluoride varnish |
4,308 |
4,137 |
$86K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,404 |
2,230 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,709 |
2,599 |
$61K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,010 |
494 |
$55K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
640 |
307 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,434 |
1,371 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
689 |
408 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,590 |
1,522 |
$26K |
| D1110 |
Prophylaxis - adult |
713 |
680 |
$24K |
| D0330 |
Panoramic radiographic image |
648 |
627 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
263 |
164 |
$19K |
| D0274 |
Bitewings - four radiographic images |
558 |
535 |
$14K |
| D1351 |
Sealant - per tooth |
541 |
189 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
726 |
664 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
182 |
161 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
224 |
120 |
$2K |
| D2332 |
|
24 |
12 |
$1K |
| D2330 |
|
21 |
13 |
$999.30 |
| D0145 |
Oral evaluation for a patient under three years of age |
20 |
16 |
$341.60 |
| D1999 |
|
24 |
24 |
$0.00 |