| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,546 |
2,239 |
$579K |
| D1120 |
Prophylaxis - child |
8,535 |
8,526 |
$365K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,575 |
755 |
$312K |
| D0120 |
Periodic oral evaluation - established patient |
7,229 |
7,224 |
$255K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,884 |
1,078 |
$172K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,663 |
5,656 |
$154K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,258 |
737 |
$122K |
| D1206 |
Topical application of fluoride varnish |
3,371 |
3,369 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,569 |
1,563 |
$98K |
| D0210 |
Intraoral - complete series of radiographic images |
1,140 |
1,113 |
$86K |
| D1351 |
Sealant - per tooth |
2,552 |
1,030 |
$84K |
| D0140 |
Limited oral evaluation - problem focused |
1,381 |
1,356 |
$84K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
577 |
355 |
$75K |
| D0272 |
Bitewings - two radiographic images |
2,783 |
2,776 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,214 |
822 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,540 |
1,531 |
$29K |
| D1110 |
Prophylaxis - adult |
517 |
517 |
$29K |
| D0240 |
|
985 |
638 |
$21K |
| D0274 |
Bitewings - four radiographic images |
260 |
260 |
$10K |
| D2332 |
|
41 |
25 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
91 |
91 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
13 |
$3K |
| D9920 |
|
29 |
28 |
$2K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,345 |
2,219 |
$110.00 |