| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,076 |
2,286 |
$325K |
| D1120 |
Prophylaxis - child |
10,512 |
10,244 |
$263K |
| D0120 |
Periodic oral evaluation - established patient |
13,457 |
13,175 |
$258K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,531 |
2,209 |
$228K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,470 |
12,135 |
$183K |
| D1110 |
Prophylaxis - adult |
4,556 |
4,462 |
$166K |
| D1999 |
|
8,713 |
7,970 |
$161K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,588 |
5,124 |
$117K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,131 |
1,212 |
$116K |
| D0272 |
Bitewings - two radiographic images |
4,644 |
4,489 |
$83K |
| D0330 |
Panoramic radiographic image |
1,703 |
1,628 |
$79K |
| D1206 |
Topical application of fluoride varnish |
2,726 |
2,654 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,443 |
2,375 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,001 |
1,896 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
2,272 |
2,179 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
850 |
756 |
$23K |
| D1351 |
Sealant - per tooth |
909 |
338 |
$21K |
| D0240 |
|
752 |
385 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
132 |
86 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
71 |
43 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
762 |
688 |
$7K |
| D2332 |
|
16 |
13 |
$1K |