| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,866 |
6,684 |
$287K |
| D1351 |
Sealant - per tooth |
2,373 |
1,851 |
$207K |
| D0120 |
Periodic oral evaluation - established patient |
6,973 |
6,783 |
$199K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,748 |
6,571 |
$179K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,099 |
1,778 |
$148K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
907 |
821 |
$83K |
| D0274 |
Bitewings - four radiographic images |
2,604 |
2,537 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
4,575 |
4,351 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,136 |
1,100 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,521 |
1,448 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,777 |
1,751 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
316 |
289 |
$19K |
| D1110 |
Prophylaxis - adult |
375 |
375 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,292 |
3,135 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
315 |
296 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
236 |
224 |
$15K |
| D9110 |
|
237 |
219 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
92 |
71 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
92 |
72 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
53 |
44 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
50 |
45 |
$645.80 |
| D2940 |
|
12 |
12 |
$0.00 |