| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,463 |
7,425 |
$232K |
| D0120 |
Periodic oral evaluation - established patient |
8,820 |
8,764 |
$213K |
| D1206 |
Topical application of fluoride varnish |
9,809 |
9,736 |
$183K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,021 |
481 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,845 |
1,157 |
$133K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,867 |
1,769 |
$75K |
| D1110 |
Prophylaxis - adult |
1,872 |
1,856 |
$72K |
| D0272 |
Bitewings - two radiographic images |
4,018 |
3,984 |
$70K |
| D1351 |
Sealant - per tooth |
2,198 |
536 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
805 |
498 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
853 |
688 |
$47K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
493 |
252 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
830 |
828 |
$22K |
| D0330 |
Panoramic radiographic image |
542 |
541 |
$20K |
| D1330 |
|
3,479 |
3,459 |
$18K |
| D1310 |
|
3,451 |
3,431 |
$17K |
| D0603 |
|
1,763 |
1,750 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
372 |
364 |
$15K |
| D0602 |
|
1,040 |
1,037 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
232 |
230 |
$10K |
| D0274 |
Bitewings - four radiographic images |
300 |
296 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
478 |
472 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
179 |
179 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
246 |
243 |
$3K |
| D0240 |
|
90 |
83 |
$2K |
| D0601 |
|
153 |
153 |
$1K |
| D9920 |
|
13 |
13 |
$830.50 |
| D9420 |
|
250 |
242 |
$0.00 |