| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,301 |
1,184 |
$431K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
911 |
403 |
$145K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,392 |
580 |
$139K |
| D1120 |
Prophylaxis - child |
3,763 |
3,760 |
$138K |
| D0350 |
|
1,942 |
1,757 |
$131K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,013 |
434 |
$101K |
| D1206 |
Topical application of fluoride varnish |
4,667 |
4,659 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
3,476 |
3,469 |
$87K |
| D7961 |
|
365 |
362 |
$74K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
328 |
109 |
$44K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
485 |
150 |
$43K |
| D1110 |
Prophylaxis - adult |
712 |
708 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
761 |
761 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,353 |
1,351 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
810 |
769 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
897 |
882 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,550 |
1,503 |
$20K |
| D0240 |
|
531 |
531 |
$19K |
| D2332 |
|
111 |
55 |
$17K |
| D2330 |
|
139 |
73 |
$14K |
| D1351 |
Sealant - per tooth |
294 |
116 |
$11K |
| D9248 |
|
55 |
54 |
$8K |
| D0330 |
Panoramic radiographic image |
98 |
98 |
$5K |
| D3120 |
|
128 |
37 |
$5K |
| D0274 |
Bitewings - four radiographic images |
148 |
148 |
$5K |
| D9219 |
|
100 |
100 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
108 |
108 |
$4K |
| D7960 |
|
12 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
173 |
166 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
31 |
30 |
$1K |