| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,169 |
3,120 |
$181K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,063 |
444 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,480 |
798 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,101 |
2,062 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,476 |
3,412 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
990 |
593 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,086 |
557 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,730 |
1,706 |
$39K |
| D1351 |
Sealant - per tooth |
1,929 |
601 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,213 |
1,089 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,627 |
1,579 |
$29K |
| D0330 |
Panoramic radiographic image |
674 |
657 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,347 |
2,267 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,878 |
2,095 |
$22K |
| D1110 |
Prophylaxis - adult |
301 |
296 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
140 |
83 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
190 |
179 |
$6K |
| D2331 |
|
23 |
16 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
20 |
20 |
$644.61 |
| D9420 |
|
15 |
12 |
$473.20 |
| D9986 |
|
580 |
544 |
$294.00 |
| D9987 |
|
295 |
265 |
$123.00 |