| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,283 |
6,922 |
$174K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,543 |
4,413 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,257 |
624 |
$103K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,394 |
6,972 |
$100K |
| D0272 |
Bitewings - two radiographic images |
6,360 |
5,125 |
$84K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
709 |
308 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
3,032 |
2,722 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
858 |
413 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
841 |
507 |
$51K |
| D1351 |
Sealant - per tooth |
2,441 |
643 |
$51K |
| D0330 |
Panoramic radiographic image |
1,417 |
1,215 |
$45K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
391 |
183 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,338 |
1,818 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
667 |
568 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
207 |
206 |
$14K |
| D9248 |
|
611 |
502 |
$14K |
| D1110 |
Prophylaxis - adult |
432 |
303 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
108 |
102 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
322 |
289 |
$4K |
| D1999 |
|
138 |
116 |
$0.00 |