| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,961 |
8,933 |
$381K |
| D0120 |
Periodic oral evaluation - established patient |
8,646 |
8,616 |
$251K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,893 |
8,865 |
$240K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,846 |
2,755 |
$187K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,158 |
1,001 |
$140K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,271 |
1,130 |
$78K |
| D1351 |
Sealant - per tooth |
1,439 |
781 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,727 |
5,398 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,156 |
1,032 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
725 |
643 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
6,266 |
6,233 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,059 |
1,058 |
$27K |
| D0274 |
Bitewings - four radiographic images |
899 |
897 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
245 |
222 |
$15K |
| D0330 |
Panoramic radiographic image |
571 |
555 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
785 |
774 |
$15K |
| D1354 |
|
494 |
268 |
$11K |
| D0272 |
Bitewings - two radiographic images |
357 |
355 |
$4K |
| D1510 |
|
44 |
43 |
$3K |