| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,459 |
1,318 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,646 |
1,422 |
$36K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
314 |
85 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,687 |
1,524 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
908 |
811 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
233 |
112 |
$16K |
| D0272 |
Bitewings - two radiographic images |
971 |
849 |
$16K |
| D1110 |
Prophylaxis - adult |
357 |
302 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,141 |
1,024 |
$13K |
| D9248 |
|
217 |
201 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
248 |
232 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
347 |
333 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
76 |
37 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
104 |
101 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
74 |
38 |
$4K |
| D1206 |
Topical application of fluoride varnish |
169 |
136 |
$3K |
| D1351 |
Sealant - per tooth |
100 |
35 |
$3K |
| D0330 |
Panoramic radiographic image |
42 |
39 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
53 |
50 |
$735.00 |