| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,567 |
2,203 |
$469K |
| D1120 |
Prophylaxis - child |
9,835 |
9,696 |
$303K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,237 |
5,163 |
$177K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,029 |
9,888 |
$177K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,251 |
1,085 |
$145K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,294 |
4,155 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
4,850 |
4,786 |
$107K |
| D0274 |
Bitewings - four radiographic images |
2,430 |
2,385 |
$69K |
| D7240 |
Removal of impacted tooth - completely bony |
346 |
240 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,017 |
502 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
591 |
429 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,277 |
2,246 |
$45K |
| D0330 |
Panoramic radiographic image |
962 |
938 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
885 |
863 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
251 |
246 |
$7K |
| D8660 |
|
58 |
58 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
37 |
27 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
258 |
235 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20 |
14 |
$2K |
| D1110 |
Prophylaxis - adult |
58 |
57 |
$2K |
| D2330 |
|
29 |
13 |
$2K |