| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
12,410 |
11,938 |
$433K |
| D0120 |
Periodic oral evaluation - established patient |
11,311 |
10,908 |
$365K |
| D1120 |
Prophylaxis - child |
10,152 |
9,772 |
$344K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,632 |
890 |
$153K |
| D0272 |
Bitewings - two radiographic images |
5,553 |
5,341 |
$129K |
| D1351 |
Sealant - per tooth |
3,953 |
1,010 |
$110K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
809 |
297 |
$105K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,421 |
2,315 |
$60K |
| D1110 |
Prophylaxis - adult |
1,112 |
1,083 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
3,382 |
3,212 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
695 |
382 |
$50K |
| D0330 |
Panoramic radiographic image |
680 |
645 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
747 |
699 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,715 |
1,376 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
524 |
512 |
$18K |
| D9248 |
|
164 |
161 |
$16K |
| D9420 |
|
108 |
103 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
268 |
263 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
126 |
78 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
84 |
38 |
$7K |
| D2390 |
|
38 |
12 |
$6K |
| D0274 |
Bitewings - four radiographic images |
37 |
37 |
$1K |