| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,132 |
2,997 |
$432K |
| D1120 |
Prophylaxis - child |
9,322 |
9,280 |
$277K |
| D0120 |
Periodic oral evaluation - established patient |
11,684 |
11,634 |
$230K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,903 |
8,857 |
$131K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,916 |
1,376 |
$121K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,163 |
4,903 |
$111K |
| D1110 |
Prophylaxis - adult |
2,569 |
2,556 |
$99K |
| D1206 |
Topical application of fluoride varnish |
3,242 |
3,215 |
$91K |
| D0330 |
Panoramic radiographic image |
1,795 |
1,785 |
$90K |
| D0272 |
Bitewings - two radiographic images |
4,402 |
4,381 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,124 |
676 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
583 |
468 |
$50K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
562 |
419 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,673 |
3,593 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,333 |
1,322 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,026 |
1,013 |
$25K |
| D2332 |
|
284 |
180 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,398 |
1,094 |
$22K |
| D1351 |
Sealant - per tooth |
513 |
181 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
489 |
482 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
137 |
102 |
$12K |
| D2335 |
|
47 |
25 |
$5K |
| D2330 |
|
32 |
25 |
$2K |