| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,990 |
7,930 |
$261K |
| D0120 |
Periodic oral evaluation - established patient |
7,958 |
7,899 |
$203K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,127 |
1,240 |
$156K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,007 |
414 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,539 |
5,506 |
$103K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,835 |
2,600 |
$95K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,793 |
1,788 |
$76K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,249 |
822 |
$75K |
| D0272 |
Bitewings - two radiographic images |
3,558 |
3,525 |
$67K |
| D1206 |
Topical application of fluoride varnish |
2,616 |
2,587 |
$60K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
391 |
153 |
$35K |
| D9248 |
|
274 |
248 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,774 |
1,677 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
531 |
519 |
$21K |
| D1110 |
Prophylaxis - adult |
485 |
478 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
292 |
174 |
$20K |
| D0330 |
Panoramic radiographic image |
352 |
349 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
718 |
687 |
$10K |
| D1351 |
Sealant - per tooth |
127 |
38 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$646.39 |
| D1999 |
|
14 |
12 |
$35.00 |