| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
33,503 |
33,502 |
$1.18M |
| D0120 |
Periodic oral evaluation - established patient |
35,957 |
35,956 |
$848K |
| D1206 |
Topical application of fluoride varnish |
38,766 |
38,765 |
$638K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,163 |
1,237 |
$406K |
| D1110 |
Prophylaxis - adult |
6,781 |
6,781 |
$343K |
| D0272 |
Bitewings - two radiographic images |
15,494 |
15,494 |
$296K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,816 |
1,961 |
$294K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,891 |
1,999 |
$243K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,091 |
6,891 |
$231K |
| D0330 |
Panoramic radiographic image |
3,147 |
3,147 |
$159K |
| D1351 |
Sealant - per tooth |
4,293 |
1,153 |
$131K |
| D0140 |
Limited oral evaluation - problem focused |
3,250 |
3,195 |
$126K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,367 |
870 |
$125K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,001 |
2,001 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,632 |
1,632 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
4,446 |
4,404 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,208 |
1,346 |
$30K |
| D0240 |
|
941 |
729 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
190 |
100 |
$16K |
| D9420 |
|
104 |
104 |
$9K |
| D9248 |
|
65 |
65 |
$4K |
| D2330 |
|
47 |
28 |
$3K |
| D2332 |
|
21 |
14 |
$2K |