| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,888 |
9,818 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,225 |
1,998 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
10,550 |
10,477 |
$59K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,792 |
687 |
$45K |
| D0272 |
Bitewings - two radiographic images |
6,816 |
6,774 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
11,312 |
11,168 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,609 |
10,419 |
$24K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,473 |
589 |
$24K |
| D1206 |
Topical application of fluoride varnish |
6,315 |
6,259 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,073 |
6,042 |
$23K |
| D1110 |
Prophylaxis - adult |
2,627 |
2,602 |
$22K |
| D0274 |
Bitewings - four radiographic images |
3,836 |
3,798 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,065 |
566 |
$18K |
| D0330 |
Panoramic radiographic image |
1,706 |
1,691 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
888 |
410 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,496 |
1,482 |
$11K |
| D1351 |
Sealant - per tooth |
1,271 |
396 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
263 |
197 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
926 |
864 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
353 |
347 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
240 |
235 |
$2K |
| D9248 |
|
42 |
39 |
$567.69 |
| D0160 |
|
12 |
12 |
$36.81 |
| D0603 |
|
1,275 |
1,224 |
$0.00 |
| D0601 |
|
2,014 |
1,942 |
$0.00 |
| D0602 |
|
1,823 |
1,726 |
$0.00 |