| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
916 |
539 |
$95K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
679 |
227 |
$93K |
| D1120 |
Prophylaxis - child |
2,341 |
2,187 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,192 |
2,055 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,133 |
1,023 |
$46K |
| D1351 |
Sealant - per tooth |
1,563 |
452 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,418 |
2,267 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
409 |
299 |
$32K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
373 |
172 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
470 |
281 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,633 |
1,478 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,900 |
1,284 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,223 |
1,137 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
143 |
112 |
$18K |
| D9420 |
|
126 |
110 |
$13K |
| D2390 |
|
81 |
27 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
260 |
238 |
$11K |
| D1510 |
|
94 |
44 |
$9K |
| D0330 |
Panoramic radiographic image |
180 |
170 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
197 |
174 |
$7K |
| D1110 |
Prophylaxis - adult |
133 |
129 |
$5K |
| D2330 |
|
82 |
54 |
$4K |
| D0274 |
Bitewings - four radiographic images |
68 |
62 |
$1K |
| D2331 |
|
15 |
13 |
$1K |