| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,504 |
3,482 |
$190K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,320 |
800 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,679 |
2,662 |
$76K |
| D1206 |
Topical application of fluoride varnish |
3,979 |
3,958 |
$67K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,278 |
1,214 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
655 |
452 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
802 |
563 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,338 |
1,335 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,540 |
1,533 |
$32K |
| D1110 |
Prophylaxis - adult |
545 |
544 |
$31K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
262 |
180 |
$30K |
| D2330 |
|
283 |
190 |
$14K |
| D2331 |
|
151 |
103 |
$10K |
| D9248 |
|
132 |
130 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
129 |
104 |
$8K |
| D0330 |
Panoramic radiographic image |
87 |
87 |
$6K |
| D1351 |
Sealant - per tooth |
306 |
90 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
405 |
396 |
$4K |
| D2335 |
|
20 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
271 |
95 |
$2K |