| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,330 |
3,304 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
4,484 |
4,454 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,321 |
795 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,247 |
703 |
$83K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,008 |
1,892 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,014 |
3,991 |
$75K |
| D1110 |
Prophylaxis - adult |
1,421 |
1,414 |
$53K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
442 |
328 |
$48K |
| D1351 |
Sealant - per tooth |
2,063 |
581 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
750 |
498 |
$39K |
| D0330 |
Panoramic radiographic image |
801 |
801 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,665 |
1,648 |
$28K |
| D0274 |
Bitewings - four radiographic images |
730 |
723 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
529 |
529 |
$13K |
| D0601 |
|
481 |
477 |
$5K |
| D9920 |
|
31 |
31 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
29 |
25 |
$2K |
| D1330 |
|
467 |
463 |
$2K |
| D9110 |
|
12 |
12 |
$403.00 |