| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,740 |
1,608 |
$223K |
| D1110 |
Prophylaxis - adult |
4,192 |
4,080 |
$175K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,321 |
1,563 |
$167K |
| D1206 |
Topical application of fluoride varnish |
8,101 |
7,918 |
$165K |
| D1120 |
Prophylaxis - child |
4,199 |
4,129 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
5,583 |
5,444 |
$131K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,054 |
3,586 |
$114K |
| D0274 |
Bitewings - four radiographic images |
3,340 |
3,268 |
$85K |
| D0330 |
Panoramic radiographic image |
2,026 |
1,980 |
$77K |
| D1351 |
Sealant - per tooth |
2,130 |
787 |
$61K |
| D2394 |
|
602 |
413 |
$53K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
365 |
227 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,407 |
1,380 |
$39K |
| D0272 |
Bitewings - two radiographic images |
2,158 |
2,128 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,008 |
1,716 |
$20K |
| D1353 |
|
710 |
213 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
138 |
87 |
$9K |
| D2950 |
|
33 |
25 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
372 |
233 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$702.54 |
| D1208 |
Topical application of fluoride, excluding varnish |
26 |
26 |
$557.60 |
| D1999 |
|
48 |
47 |
$0.00 |