| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,394 |
7,377 |
$290K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,725 |
721 |
$282K |
| D1206 |
Topical application of fluoride varnish |
7,551 |
7,534 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
4,877 |
4,873 |
$134K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,335 |
618 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,764 |
1,756 |
$64K |
| D1351 |
Sealant - per tooth |
2,023 |
597 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,654 |
1,508 |
$47K |
| D0603 |
|
6,673 |
6,646 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
581 |
297 |
$43K |
| D0272 |
Bitewings - two radiographic images |
2,726 |
2,718 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
648 |
648 |
$36K |
| D0240 |
|
2,054 |
1,136 |
$32K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,107 |
1,104 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,100 |
1,059 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,064 |
2,008 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
364 |
233 |
$19K |
| D1110 |
Prophylaxis - adult |
406 |
406 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
531 |
522 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
151 |
69 |
$11K |
| D0330 |
Panoramic radiographic image |
912 |
902 |
$9K |
| D0274 |
Bitewings - four radiographic images |
401 |
401 |
$7K |
| D2929 |
|
49 |
14 |
$5K |
| D1354 |
|
1,528 |
558 |
$4K |
| D0602 |
|
591 |
591 |
$4K |
| D1510 |
|
18 |
13 |
$2K |
| D0601 |
|
232 |
232 |
$1K |
| D1330 |
|
5,905 |
5,890 |
$0.32 |
| D1310 |
|
5,870 |
5,857 |
$0.09 |
| D3120 |
|
20 |
12 |
$0.00 |