| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,226 |
10,382 |
$360K |
| D1120 |
Prophylaxis - child |
12,173 |
10,482 |
$269K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,349 |
1,422 |
$213K |
| D1206 |
Topical application of fluoride varnish |
6,849 |
6,530 |
$141K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,220 |
346 |
$138K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,448 |
942 |
$100K |
| D0272 |
Bitewings - two radiographic images |
5,762 |
5,018 |
$92K |
| D0330 |
Panoramic radiographic image |
2,037 |
1,850 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,213 |
4,745 |
$65K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
718 |
295 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,530 |
1,291 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
388 |
213 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
940 |
856 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
339 |
326 |
$12K |
| D1110 |
Prophylaxis - adult |
104 |
81 |
$2K |
| D2335 |
|
16 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
100 |
93 |
$1K |
| D9420 |
|
127 |
124 |
$0.00 |