| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,983 |
1,943 |
$86K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
606 |
268 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
656 |
418 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
748 |
451 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
830 |
416 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,603 |
1,566 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
921 |
810 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,401 |
1,369 |
$19K |
| D1351 |
Sealant - per tooth |
1,038 |
346 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
670 |
656 |
$17K |
| D0330 |
Panoramic radiographic image |
458 |
440 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
532 |
513 |
$15K |
| D0272 |
Bitewings - two radiographic images |
740 |
719 |
$13K |
| D1206 |
Topical application of fluoride varnish |
758 |
742 |
$10K |
| D0274 |
Bitewings - four radiographic images |
366 |
354 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
905 |
870 |
$8K |
| D2335 |
|
87 |
41 |
$8K |
| D1110 |
Prophylaxis - adult |
161 |
155 |
$7K |
| D9248 |
|
80 |
65 |
$7K |
| D2330 |
|
117 |
75 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
858 |
339 |
$5K |
| D9420 |
|
41 |
38 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
43 |
28 |
$2K |
| D2331 |
|
16 |
12 |
$1K |