| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,940 |
24,940 |
$861K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,126 |
1,905 |
$641K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,802 |
3,632 |
$584K |
| D0120 |
Periodic oral evaluation - established patient |
24,574 |
24,574 |
$570K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,319 |
2,699 |
$502K |
| D1206 |
Topical application of fluoride varnish |
29,788 |
29,788 |
$486K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,849 |
9,595 |
$304K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,478 |
2,364 |
$282K |
| D1110 |
Prophylaxis - adult |
4,936 |
4,936 |
$244K |
| D9248 |
|
3,133 |
3,081 |
$206K |
| D1351 |
Sealant - per tooth |
6,793 |
1,954 |
$197K |
| D0272 |
Bitewings - two radiographic images |
8,981 |
8,981 |
$167K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,021 |
6,166 |
$158K |
| D0330 |
Panoramic radiographic image |
3,081 |
3,081 |
$154K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,926 |
2,926 |
$136K |
| D0140 |
Limited oral evaluation - problem focused |
3,401 |
3,355 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,952 |
2,952 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
8,997 |
8,911 |
$114K |
| D0274 |
Bitewings - four radiographic images |
2,576 |
2,576 |
$71K |
| D0240 |
|
3,133 |
2,908 |
$59K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
262 |
164 |
$22K |
| D9420 |
|
88 |
88 |
$8K |
| D9310 |
|
111 |
111 |
$7K |
| D2332 |
|
41 |
25 |
$4K |
| D2330 |
|
35 |
26 |
$2K |