| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,307 |
2,224 |
$131K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
608 |
187 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
866 |
426 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,373 |
1,321 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,408 |
1,354 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,125 |
2,026 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
321 |
142 |
$25K |
| D0330 |
Panoramic radiographic image |
353 |
319 |
$23K |
| D1351 |
Sealant - per tooth |
999 |
303 |
$21K |
| D0272 |
Bitewings - two radiographic images |
967 |
939 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
539 |
448 |
$16K |
| D1110 |
Prophylaxis - adult |
283 |
266 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
931 |
870 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
989 |
513 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
145 |
136 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
22 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
26 |
26 |
$934.50 |
| D9986 |
|
23 |
22 |
$24.00 |