| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,979 |
3,923 |
$214K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,121 |
398 |
$124K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,614 |
911 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,920 |
2,888 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,095 |
723 |
$61K |
| D1206 |
Topical application of fluoride varnish |
3,613 |
3,574 |
$59K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,515 |
1,471 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,730 |
1,701 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
789 |
406 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,290 |
2,252 |
$42K |
| D0330 |
Panoramic radiographic image |
708 |
699 |
$37K |
| D1110 |
Prophylaxis - adult |
474 |
472 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
943 |
920 |
$13K |
| D1351 |
Sealant - per tooth |
434 |
184 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
791 |
775 |
$8K |
| D9420 |
|
113 |
109 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
458 |
241 |
$3K |
| D2332 |
|
31 |
16 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
55 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
30 |
13 |
$2K |