| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,560 |
1,559 |
$78K |
| D1310 |
|
1,113 |
1,111 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
746 |
746 |
$49K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
326 |
225 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,519 |
1,518 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
570 |
569 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
513 |
353 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
704 |
651 |
$28K |
| D0145 |
Oral evaluation for a patient under three years of age |
302 |
302 |
$20K |
| D1351 |
Sealant - per tooth |
527 |
184 |
$19K |
| D9920 |
|
109 |
106 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,185 |
730 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
226 |
164 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
130 |
99 |
$13K |
| D0603 |
|
775 |
774 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
390 |
382 |
$5K |
| D0272 |
Bitewings - two radiographic images |
424 |
400 |
$5K |
| D0601 |
|
268 |
268 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
36 |
$2K |
| D0350 |
|
192 |
73 |
$1K |
| D9430 |
|
45 |
43 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$1K |