| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,647 |
3,586 |
$194K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,657 |
726 |
$110K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
631 |
170 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,380 |
720 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,548 |
2,496 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,875 |
1,859 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
849 |
431 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,411 |
2,373 |
$40K |
| D1351 |
Sealant - per tooth |
1,946 |
618 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,001 |
961 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,847 |
1,808 |
$31K |
| D1110 |
Prophylaxis - adult |
579 |
573 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,793 |
1,761 |
$25K |
| D0330 |
Panoramic radiographic image |
616 |
610 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,282 |
1,231 |
$13K |
| D0274 |
Bitewings - four radiographic images |
411 |
408 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
919 |
742 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
205 |
198 |
$6K |
| D9248 |
|
98 |
94 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
33 |
13 |
$2K |
| D1330 |
|
454 |
437 |
$2K |