| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,971 |
4,928 |
$282K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,659 |
1,391 |
$181K |
| D0120 |
Periodic oral evaluation - established patient |
4,098 |
4,067 |
$102K |
| D1206 |
Topical application of fluoride varnish |
5,024 |
4,981 |
$84K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,638 |
1,521 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,829 |
1,817 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
633 |
397 |
$53K |
| D1110 |
Prophylaxis - adult |
921 |
916 |
$51K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
400 |
232 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
729 |
444 |
$45K |
| D0272 |
Bitewings - two radiographic images |
2,219 |
2,196 |
$43K |
| D0274 |
Bitewings - four radiographic images |
699 |
691 |
$25K |
| D0330 |
Panoramic radiographic image |
324 |
320 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
249 |
147 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,432 |
1,367 |
$15K |
| D1351 |
Sealant - per tooth |
635 |
209 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
693 |
684 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
124 |
84 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
165 |
160 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
466 |
296 |
$4K |
| D2332 |
|
42 |
26 |
$4K |
| D9248 |
|
76 |
75 |
$3K |
| D2394 |
|
21 |
12 |
$2K |