| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,991 |
649 |
$379K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,654 |
548 |
$356K |
| D9420 |
|
854 |
836 |
$212K |
| D2332 |
|
742 |
327 |
$149K |
| D7140 |
Extraction, erupted tooth or exposed root |
707 |
299 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
514 |
232 |
$79K |
| D2335 |
|
225 |
102 |
$59K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
278 |
159 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
693 |
310 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
152 |
97 |
$34K |
| D1120 |
Prophylaxis - child |
366 |
362 |
$21K |
| D9310 |
|
140 |
121 |
$16K |
| D0274 |
Bitewings - four radiographic images |
247 |
245 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
390 |
379 |
$12K |
| D1206 |
Topical application of fluoride varnish |
279 |
277 |
$10K |
| D2330 |
|
86 |
51 |
$9K |
| D0171 |
|
126 |
124 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
98 |
97 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
106 |
96 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
31 |
31 |
$2K |