| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,238 |
11,076 |
$398K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,717 |
2,705 |
$378K |
| D0120 |
Periodic oral evaluation - established patient |
12,913 |
12,744 |
$360K |
| D1351 |
Sealant - per tooth |
5,608 |
1,059 |
$146K |
| D1110 |
Prophylaxis - adult |
2,568 |
2,537 |
$134K |
| D0272 |
Bitewings - two radiographic images |
5,661 |
5,578 |
$128K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,573 |
8,469 |
$122K |
| D0220 |
Intraoral - periapical first radiographic image |
9,696 |
9,437 |
$110K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
666 |
169 |
$94K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,376 |
7,560 |
$86K |
| D1206 |
Topical application of fluoride varnish |
5,975 |
5,871 |
$84K |
| D0330 |
Panoramic radiographic image |
1,139 |
1,124 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,860 |
1,793 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,247 |
1,214 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
442 |
293 |
$41K |
| D0274 |
Bitewings - four radiographic images |
933 |
922 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
297 |
199 |
$23K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
52 |
13 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$758.79 |
| D9420 |
|
12 |
12 |
$396.62 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$204.70 |
| D0603 |
|
18,823 |
18,608 |
$0.00 |