| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,975 |
2,964 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,345 |
892 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
964 |
677 |
$46K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
770 |
306 |
$44K |
| D1120 |
Prophylaxis - child |
2,546 |
2,537 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,246 |
3,234 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,421 |
1,360 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
726 |
721 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,146 |
1,258 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,765 |
1,756 |
$18K |
| D1110 |
Prophylaxis - adult |
801 |
799 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
434 |
284 |
$15K |
| D0274 |
Bitewings - four radiographic images |
964 |
962 |
$15K |
| D0330 |
Panoramic radiographic image |
526 |
521 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,623 |
1,610 |
$10K |
| D1206 |
Topical application of fluoride varnish |
519 |
518 |
$5K |
| D1351 |
Sealant - per tooth |
282 |
91 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
230 |
227 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
152 |
152 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
52 |
16 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
76 |
76 |
$1K |
| D2330 |
|
32 |
24 |
$1K |