| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,757 |
2,627 |
$135K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
727 |
279 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,210 |
586 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
2,806 |
2,671 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,639 |
2,594 |
$40K |
| D0272 |
Bitewings - two radiographic images |
2,341 |
2,246 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
676 |
389 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
664 |
603 |
$22K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
300 |
112 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
446 |
410 |
$11K |
| D7111 |
|
227 |
121 |
$11K |
| D1110 |
Prophylaxis - adult |
182 |
175 |
$8K |
| D1206 |
Topical application of fluoride varnish |
558 |
433 |
$8K |
| D0330 |
Panoramic radiographic image |
86 |
67 |
$4K |
| D9420 |
|
43 |
43 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
12 |
$2K |
| D2330 |
|
20 |
12 |
$1K |