| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,298 |
4,214 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
4,929 |
4,831 |
$133K |
| D0145 |
Oral evaluation for a patient under three years of age |
868 |
859 |
$118K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
699 |
209 |
$72K |
| D0272 |
Bitewings - two radiographic images |
2,838 |
2,758 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,827 |
4,203 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
4,770 |
4,542 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
569 |
370 |
$50K |
| D1110 |
Prophylaxis - adult |
866 |
848 |
$44K |
| D1206 |
Topical application of fluoride varnish |
3,152 |
3,084 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,504 |
1,393 |
$37K |
| D1351 |
Sealant - per tooth |
1,376 |
392 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,080 |
2,052 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
770 |
740 |
$25K |
| D0274 |
Bitewings - four radiographic images |
643 |
624 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
143 |
102 |
$10K |
| D0330 |
Panoramic radiographic image |
150 |
149 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
30 |
13 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
26 |
$2K |
| D9420 |
|
25 |
24 |
$871.44 |
| D0140 |
Limited oral evaluation - problem focused |
38 |
38 |
$676.08 |
| D0602 |
|
3,453 |
3,418 |
$0.00 |
| D0603 |
|
3,357 |
3,299 |
$0.00 |
| D0601 |
|
41 |
41 |
$0.00 |