| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,620 |
7,450 |
$377K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,653 |
1,163 |
$304K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,425 |
1,825 |
$232K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,958 |
5,811 |
$153K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,757 |
1,556 |
$152K |
| D1206 |
Topical application of fluoride varnish |
8,243 |
8,061 |
$127K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,870 |
906 |
$122K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,160 |
1,195 |
$113K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,571 |
2,218 |
$96K |
| D0272 |
Bitewings - two radiographic images |
4,698 |
4,597 |
$87K |
| D0330 |
Panoramic radiographic image |
1,706 |
1,677 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,602 |
2,562 |
$63K |
| D1351 |
Sealant - per tooth |
2,700 |
849 |
$51K |
| D2932 |
|
386 |
171 |
$42K |
| D9420 |
|
572 |
549 |
$36K |
| D2330 |
|
604 |
370 |
$33K |
| D1110 |
Prophylaxis - adult |
665 |
649 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,072 |
1,984 |
$22K |
| D2331 |
|
170 |
122 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,396 |
1,315 |
$11K |
| D9110 |
|
170 |
167 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
153 |
153 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
30 |
$562.50 |
| D9986 |
|
1,776 |
1,357 |
$0.00 |
| D9215 |
|
17 |
15 |
$0.00 |