| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,039 |
8,811 |
$453K |
| D1120 |
Prophylaxis - child |
10,845 |
10,603 |
$393K |
| D0120 |
Periodic oral evaluation - established patient |
13,580 |
13,266 |
$389K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,781 |
2,336 |
$367K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,812 |
5,627 |
$274K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,673 |
11,444 |
$237K |
| D0272 |
Bitewings - two radiographic images |
9,460 |
9,183 |
$205K |
| D1351 |
Sealant - per tooth |
4,867 |
1,164 |
$140K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,207 |
835 |
$134K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,002 |
510 |
$123K |
| D1206 |
Topical application of fluoride varnish |
4,415 |
4,239 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,678 |
1,132 |
$117K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,868 |
2,685 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,125 |
2,285 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
4,820 |
4,642 |
$72K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
506 |
301 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
447 |
420 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,524 |
1,502 |
$22K |
| D2931 |
|
66 |
60 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
205 |
124 |
$12K |
| D0330 |
Panoramic radiographic image |
165 |
163 |
$10K |
| D2950 |
|
73 |
63 |
$8K |
| D2394 |
|
62 |
56 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$6K |
| D7111 |
|
50 |
35 |
$3K |