| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,390 |
6,174 |
$268K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,333 |
6,119 |
$143K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,959 |
1,190 |
$108K |
| D1206 |
Topical application of fluoride varnish |
6,003 |
5,779 |
$80K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
685 |
379 |
$68K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,900 |
1,747 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,412 |
930 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,814 |
2,726 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,032 |
608 |
$42K |
| D9248 |
|
303 |
282 |
$33K |
| D2330 |
|
667 |
412 |
$32K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
510 |
295 |
$28K |
| D1351 |
Sealant - per tooth |
1,436 |
469 |
$23K |
| D2335 |
|
273 |
141 |
$23K |
| D1110 |
Prophylaxis - adult |
447 |
433 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,103 |
690 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,432 |
1,366 |
$13K |
| D2331 |
|
176 |
121 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
665 |
664 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
403 |
398 |
$8K |
| D0330 |
Panoramic radiographic image |
105 |
105 |
$4K |
| D9110 |
|
43 |
41 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
14 |
$966.42 |