| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,389 |
1,739 |
$304K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,895 |
1,882 |
$263K |
| D1120 |
Prophylaxis - child |
5,219 |
5,182 |
$188K |
| D0120 |
Periodic oral evaluation - established patient |
4,926 |
4,878 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,731 |
1,056 |
$121K |
| D0272 |
Bitewings - two radiographic images |
4,629 |
4,602 |
$107K |
| D1206 |
Topical application of fluoride varnish |
6,065 |
6,020 |
$88K |
| D1351 |
Sealant - per tooth |
2,865 |
653 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,850 |
1,829 |
$62K |
| D1110 |
Prophylaxis - adult |
985 |
976 |
$53K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
284 |
120 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,169 |
1,127 |
$31K |
| D0274 |
Bitewings - four radiographic images |
884 |
875 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,633 |
1,594 |
$20K |
| D2331 |
|
188 |
122 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,715 |
580 |
$18K |
| D9248 |
|
74 |
71 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
67 |
41 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
26 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
24 |
24 |
$352.80 |
| D0602 |
|
3,457 |
3,426 |
$0.00 |
| D0601 |
|
710 |
708 |
$0.00 |
| D0603 |
|
4,456 |
4,413 |
$0.00 |