| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
333 |
189 |
$68K |
| D1120 |
Prophylaxis - child |
942 |
942 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
994 |
994 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
271 |
185 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
953 |
953 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
416 |
407 |
$32K |
| D0272 |
Bitewings - two radiographic images |
421 |
421 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
420 |
417 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
35 |
14 |
$8K |
| D1110 |
Prophylaxis - adult |
87 |
87 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
79 |
79 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
256 |
214 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
30 |
13 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
13 |
$3K |
| D1351 |
Sealant - per tooth |
41 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
32 |
32 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$1K |