| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,674 |
7,572 |
$190K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,509 |
627 |
$140K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,642 |
7,544 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
5,887 |
5,835 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,345 |
691 |
$98K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,331 |
644 |
$67K |
| D0272 |
Bitewings - two radiographic images |
2,997 |
2,954 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,878 |
1,835 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,465 |
1,427 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,108 |
1,981 |
$36K |
| D1351 |
Sealant - per tooth |
1,600 |
354 |
$31K |
| D0330 |
Panoramic radiographic image |
676 |
669 |
$27K |
| D7960 |
|
161 |
108 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,372 |
906 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,514 |
1,442 |
$14K |
| D7962 |
|
111 |
111 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
231 |
164 |
$14K |
| D7961 |
|
101 |
101 |
$13K |
| D1110 |
Prophylaxis - adult |
271 |
268 |
$9K |
| D0274 |
Bitewings - four radiographic images |
207 |
203 |
$5K |
| D0240 |
|
285 |
200 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
146 |
144 |
$3K |
| D1510 |
|
19 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$1K |