| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,781 |
2,513 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
2,570 |
2,347 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,189 |
606 |
$60K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
624 |
297 |
$48K |
| D9248 |
|
510 |
430 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
771 |
340 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,781 |
1,580 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,021 |
2,741 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,048 |
2,313 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,246 |
1,056 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
497 |
257 |
$18K |
| D0272 |
Bitewings - two radiographic images |
914 |
859 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
433 |
364 |
$12K |
| D1351 |
Sealant - per tooth |
610 |
149 |
$12K |
| D1110 |
Prophylaxis - adult |
185 |
184 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
284 |
265 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
173 |
171 |
$9K |
| D0274 |
Bitewings - four radiographic images |
178 |
172 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
46 |
36 |
$3K |
| D0330 |
Panoramic radiographic image |
32 |
32 |
$1K |