| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,832 |
4,634 |
$158K |
| D0120 |
Periodic oral evaluation - established patient |
5,360 |
5,120 |
$137K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
854 |
246 |
$111K |
| D0272 |
Bitewings - two radiographic images |
4,611 |
4,420 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,293 |
5,319 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,441 |
5,203 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
6,561 |
6,137 |
$70K |
| D1351 |
Sealant - per tooth |
2,767 |
673 |
$67K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,392 |
1,285 |
$33K |
| D0145 |
Oral evaluation for a patient under three years of age |
203 |
194 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
116 |
77 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
145 |
142 |
$5K |
| D1330 |
|
6,730 |
6,434 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
20 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
27 |
26 |
$680.78 |
| D0603 |
|
7,938 |
7,706 |
$0.00 |
| D1999 |
|
2,346 |
2,187 |
$0.00 |