| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,822 |
16,474 |
$867K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
21,971 |
21,457 |
$592K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,014 |
5,141 |
$544K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,111 |
1,079 |
$356K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,634 |
3,134 |
$253K |
| D1110 |
Prophylaxis - adult |
4,248 |
4,141 |
$218K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,849 |
2,104 |
$197K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,927 |
4,737 |
$184K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,469 |
1,070 |
$160K |
| D0272 |
Bitewings - two radiographic images |
7,754 |
7,576 |
$139K |
| D2331 |
|
1,761 |
1,081 |
$120K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,205 |
1,030 |
$99K |
| D2332 |
|
1,179 |
737 |
$96K |
| D2330 |
|
1,442 |
866 |
$78K |
| D0330 |
Panoramic radiographic image |
1,941 |
1,887 |
$75K |
| D9420 |
|
1,075 |
1,045 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,917 |
1,881 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,809 |
1,733 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,820 |
3,727 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
4,130 |
3,961 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,067 |
1,064 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,816 |
1,723 |
$28K |
| D2335 |
|
251 |
160 |
$24K |
| D1330 |
|
236 |
234 |
$3K |
| D1310 |
|
206 |
204 |
$3K |