| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,700 |
1,527 |
$231K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,785 |
1,605 |
$209K |
| D1120 |
Prophylaxis - child |
6,097 |
5,967 |
$187K |
| D0272 |
Bitewings - two radiographic images |
8,503 |
8,294 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
7,902 |
7,722 |
$170K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,805 |
7,631 |
$136K |
| D1351 |
Sealant - per tooth |
3,992 |
1,617 |
$97K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,269 |
900 |
$91K |
| D1110 |
Prophylaxis - adult |
1,983 |
1,938 |
$83K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,284 |
2,082 |
$71K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
804 |
411 |
$47K |
| D0240 |
|
1,382 |
1,215 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,037 |
988 |
$31K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
167 |
95 |
$19K |
| D0330 |
Panoramic radiographic image |
133 |
132 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
207 |
200 |
$6K |