| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,636 |
3,621 |
$633K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,762 |
1,629 |
$318K |
| D1120 |
Prophylaxis - child |
10,442 |
10,355 |
$303K |
| D0120 |
Periodic oral evaluation - established patient |
13,218 |
13,126 |
$267K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,227 |
1,808 |
$203K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,452 |
7,070 |
$186K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,994 |
2,078 |
$170K |
| D1206 |
Topical application of fluoride varnish |
10,392 |
10,296 |
$162K |
| D1110 |
Prophylaxis - adult |
3,513 |
3,510 |
$153K |
| D0272 |
Bitewings - two radiographic images |
4,688 |
4,655 |
$82K |
| D9248 |
|
602 |
589 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,379 |
2,376 |
$69K |
| D9310 |
|
1,448 |
1,432 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,671 |
3,671 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
1,628 |
1,606 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
2,008 |
1,960 |
$29K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
319 |
211 |
$27K |
| D0602 |
|
2,870 |
2,856 |
$26K |
| D0603 |
|
2,531 |
2,520 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
107 |
79 |
$14K |
| D1351 |
Sealant - per tooth |
503 |
178 |
$12K |
| D2332 |
|
59 |
40 |
$6K |
| D0240 |
|
188 |
188 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
120 |
120 |
$3K |
| D0330 |
Panoramic radiographic image |
50 |
50 |
$2K |
| D2330 |
|
22 |
16 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
26 |
$732.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
13 |
$160.02 |