| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,842 |
1,653 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
2,012 |
1,818 |
$49K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
400 |
148 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,943 |
1,744 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
507 |
248 |
$29K |
| D1110 |
Prophylaxis - adult |
448 |
406 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
470 |
263 |
$23K |
| D0272 |
Bitewings - two radiographic images |
957 |
849 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
384 |
142 |
$16K |
| D0330 |
Panoramic radiographic image |
368 |
317 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
243 |
214 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
263 |
234 |
$8K |
| D0274 |
Bitewings - four radiographic images |
238 |
215 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
115 |
101 |
$4K |
| D9420 |
|
65 |
45 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
219 |
184 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
49 |
26 |
$2K |
| D2331 |
|
31 |
12 |
$1K |
| D2330 |
|
17 |
13 |
$977.46 |
| D1351 |
Sealant - per tooth |
65 |
13 |
$717.98 |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
12 |
$127.91 |