| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,390 |
9,321 |
$319K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,080 |
1,406 |
$212K |
| D0120 |
Periodic oral evaluation - established patient |
9,004 |
8,929 |
$206K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,638 |
738 |
$206K |
| D1206 |
Topical application of fluoride varnish |
10,482 |
10,401 |
$168K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,159 |
568 |
$108K |
| D0272 |
Bitewings - two radiographic images |
5,333 |
5,299 |
$98K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,851 |
2,738 |
$89K |
| D1110 |
Prophylaxis - adult |
1,314 |
1,302 |
$63K |
| D1351 |
Sealant - per tooth |
1,581 |
625 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,101 |
1,100 |
$43K |
| D0145 |
Oral evaluation for a patient under three years of age |
770 |
770 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,102 |
3,064 |
$39K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
457 |
252 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,311 |
1,488 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
565 |
558 |
$21K |
| D0330 |
Panoramic radiographic image |
368 |
368 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
232 |
174 |
$18K |
| D1354 |
|
987 |
357 |
$11K |
| D9310 |
|
120 |
120 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
28 |
$4K |
| D7111 |
|
22 |
12 |
$1K |