| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,041 |
2,927 |
$293K |
| D1351 |
Sealant - per tooth |
6,755 |
2,082 |
$257K |
| D1120 |
Prophylaxis - child |
6,666 |
6,634 |
$227K |
| D1206 |
Topical application of fluoride varnish |
9,978 |
9,901 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
7,711 |
7,671 |
$181K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,626 |
3,482 |
$168K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,091 |
1,633 |
$122K |
| D1110 |
Prophylaxis - adult |
2,832 |
2,817 |
$115K |
| D0274 |
Bitewings - four radiographic images |
2,978 |
2,962 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,211 |
901 |
$90K |
| D0272 |
Bitewings - two radiographic images |
3,873 |
3,851 |
$73K |
| D1320 |
|
4,505 |
4,349 |
$67K |
| D0603 |
|
6,705 |
6,672 |
$66K |
| D1310 |
|
9,308 |
9,261 |
$47K |
| D1330 |
|
9,298 |
9,253 |
$47K |
| D9920 |
|
329 |
325 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
287 |
263 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
481 |
414 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
3,706 |
3,674 |
$35K |
| D0330 |
Panoramic radiographic image |
784 |
778 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,792 |
2,774 |
$28K |
| D0145 |
Oral evaluation for a patient under three years of age |
989 |
982 |
$23K |
| D0602 |
|
1,912 |
1,901 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
475 |
473 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
23 |
14 |
$2K |
| D0601 |
|
50 |
50 |
$500.00 |
| D1354 |
|
73 |
21 |
$360.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$312.26 |