| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,891 |
8,684 |
$462K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,495 |
2,349 |
$293K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,857 |
804 |
$208K |
| D0120 |
Periodic oral evaluation - established patient |
7,460 |
7,302 |
$177K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,783 |
8,595 |
$137K |
| D0272 |
Bitewings - two radiographic images |
6,249 |
6,065 |
$108K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,897 |
970 |
$103K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,165 |
2,887 |
$97K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,643 |
1,082 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,309 |
2,235 |
$62K |
| D0330 |
Panoramic radiographic image |
815 |
795 |
$44K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
417 |
248 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
313 |
237 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,814 |
1,747 |
$20K |
| D1110 |
Prophylaxis - adult |
219 |
212 |
$12K |
| D1351 |
Sealant - per tooth |
487 |
196 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
220 |
216 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
839 |
519 |
$7K |
| D1206 |
Topical application of fluoride varnish |
462 |
431 |
$6K |
| D1510 |
|
35 |
25 |
$5K |
| D2331 |
|
45 |
25 |
$3K |
| D2335 |
|
21 |
12 |
$2K |
| D2330 |
|
24 |
13 |
$1K |
| D0240 |
|
73 |
68 |
$716.10 |