| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,849 |
2,370 |
$390K |
| D1120 |
Prophylaxis - child |
11,600 |
11,072 |
$305K |
| D0120 |
Periodic oral evaluation - established patient |
14,693 |
14,022 |
$259K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,812 |
15,142 |
$220K |
| D1999 |
|
9,625 |
9,028 |
$181K |
| D0330 |
Panoramic radiographic image |
2,618 |
2,495 |
$121K |
| D0272 |
Bitewings - two radiographic images |
6,831 |
6,536 |
$115K |
| D1110 |
Prophylaxis - adult |
3,328 |
3,179 |
$112K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,363 |
3,162 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,377 |
496 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,972 |
1,876 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
418 |
77 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
594 |
316 |
$32K |
| D9110 |
|
822 |
779 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,361 |
1,273 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,047 |
1,948 |
$21K |
| D1351 |
Sealant - per tooth |
388 |
105 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
238 |
215 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
147 |
106 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
58 |
25 |
$4K |
| D0240 |
|
209 |
98 |
$3K |
| D1206 |
Topical application of fluoride varnish |
150 |
114 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35 |
28 |
$348.00 |