| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,732 |
3,560 |
$183K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,613 |
697 |
$174K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,056 |
950 |
$104K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,909 |
1,712 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,093 |
648 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,863 |
2,733 |
$55K |
| D1206 |
Topical application of fluoride varnish |
3,427 |
3,256 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
649 |
457 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,498 |
1,437 |
$43K |
| D0330 |
Panoramic radiographic image |
1,101 |
1,048 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,033 |
954 |
$30K |
| D1351 |
Sealant - per tooth |
1,662 |
506 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,537 |
1,460 |
$26K |
| D1110 |
Prophylaxis - adult |
445 |
422 |
$22K |
| D0274 |
Bitewings - four radiographic images |
698 |
666 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,488 |
1,342 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
861 |
831 |
$11K |
| D2335 |
|
61 |
39 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
757 |
374 |
$5K |
| D9248 |
|
78 |
69 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
37 |
25 |
$2K |
| D9420 |
|
75 |
74 |
$811.20 |
| D0603 |
|
15 |
14 |
$0.00 |