| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,259 |
18,937 |
$613K |
| D0120 |
Periodic oral evaluation - established patient |
17,965 |
17,637 |
$406K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,650 |
1,368 |
$393K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,343 |
2,325 |
$257K |
| D1206 |
Topical application of fluoride varnish |
11,668 |
11,485 |
$230K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,946 |
1,673 |
$206K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,356 |
6,059 |
$182K |
| D1351 |
Sealant - per tooth |
6,402 |
1,819 |
$169K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,731 |
8,550 |
$166K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,689 |
680 |
$131K |
| D0330 |
Panoramic radiographic image |
2,509 |
2,467 |
$111K |
| D0272 |
Bitewings - two radiographic images |
6,075 |
5,942 |
$102K |
| D0220 |
Intraoral - periapical first radiographic image |
6,878 |
6,634 |
$81K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,259 |
3,285 |
$75K |
| D2140 |
|
1,124 |
790 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,061 |
2,031 |
$58K |
| D0145 |
Oral evaluation for a patient under three years of age |
561 |
558 |
$13K |
| D1110 |
Prophylaxis - adult |
675 |
656 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
317 |
313 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
24 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
33 |
27 |
$2K |
| D9110 |
|
30 |
28 |
$1K |
| D1354 |
|
60 |
24 |
$349.80 |
| D0274 |
Bitewings - four radiographic images |
13 |
12 |
$311.08 |