| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,868 |
1,235 |
$229K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,816 |
623 |
$219K |
| D1120 |
Prophylaxis - child |
6,015 |
5,903 |
$200K |
| D0120 |
Periodic oral evaluation - established patient |
5,262 |
5,138 |
$136K |
| D0272 |
Bitewings - two radiographic images |
3,980 |
3,838 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,106 |
557 |
$76K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,144 |
686 |
$72K |
| D1206 |
Topical application of fluoride varnish |
2,870 |
2,817 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,382 |
3,331 |
$65K |
| D1351 |
Sealant - per tooth |
2,192 |
874 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,855 |
1,685 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,018 |
948 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
3,297 |
3,047 |
$43K |
| D0145 |
Oral evaluation for a patient under three years of age |
822 |
819 |
$34K |
| D0330 |
Panoramic radiographic image |
524 |
523 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,030 |
1,629 |
$20K |
| D9420 |
|
153 |
133 |
$13K |
| D1110 |
Prophylaxis - adult |
265 |
262 |
$12K |
| D9248 |
|
79 |
69 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
463 |
450 |
$7K |
| D9997 |
|
70 |
59 |
$174.00 |