| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,463 |
9,122 |
$471K |
| D0120 |
Periodic oral evaluation - established patient |
8,939 |
8,686 |
$199K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,532 |
877 |
$169K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,341 |
8,968 |
$135K |
| D0272 |
Bitewings - two radiographic images |
5,656 |
5,455 |
$102K |
| D1110 |
Prophylaxis - adult |
1,639 |
1,590 |
$82K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,315 |
2,142 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,111 |
764 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,575 |
2,422 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
942 |
636 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
886 |
479 |
$47K |
| D0330 |
Panoramic radiographic image |
914 |
878 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,812 |
1,806 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,913 |
2,749 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,404 |
1,257 |
$18K |
| D0274 |
Bitewings - four radiographic images |
401 |
377 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
294 |
266 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
179 |
154 |
$5K |
| D1351 |
Sealant - per tooth |
234 |
83 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
46 |
26 |
$3K |
| D9986 |
|
599 |
469 |
$0.00 |
| D9987 |
|
16 |
13 |
$0.00 |