| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,431 |
1,244 |
$55K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
455 |
372 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,171 |
1,003 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,247 |
1,077 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
564 |
397 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,016 |
927 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,304 |
1,093 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
416 |
329 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
879 |
803 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
327 |
259 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,566 |
1,334 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
253 |
238 |
$4K |
| D0272 |
Bitewings - two radiographic images |
410 |
392 |
$4K |
| D2330 |
|
24 |
14 |
$761.20 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
12 |
12 |
$632.40 |
| D9310 |
|
14 |
12 |
$205.20 |