| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,481 |
7,443 |
$260K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,720 |
486 |
$217K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,016 |
1,206 |
$209K |
| D0120 |
Periodic oral evaluation - established patient |
7,107 |
7,079 |
$167K |
| D1206 |
Topical application of fluoride varnish |
8,701 |
8,664 |
$142K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,926 |
2,839 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,125 |
746 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
866 |
464 |
$76K |
| D1110 |
Prophylaxis - adult |
1,420 |
1,417 |
$72K |
| D0272 |
Bitewings - two radiographic images |
3,345 |
3,335 |
$63K |
| D1351 |
Sealant - per tooth |
1,617 |
594 |
$48K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
533 |
220 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
958 |
953 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
885 |
883 |
$36K |
| D0330 |
Panoramic radiographic image |
495 |
492 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
427 |
420 |
$17K |
| D9420 |
|
142 |
142 |
$12K |
| D0240 |
|
321 |
312 |
$6K |
| D0274 |
Bitewings - four radiographic images |
189 |
189 |
$5K |
| D1510 |
|
14 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
82 |
82 |
$1K |
| D9310 |
|
13 |
13 |
$819.00 |