| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,049 |
2,032 |
$113K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
634 |
343 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
933 |
549 |
$65K |
| D1351 |
Sealant - per tooth |
2,117 |
633 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,058 |
962 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,102 |
1,090 |
$35K |
| D1206 |
Topical application of fluoride varnish |
2,141 |
2,127 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,492 |
1,485 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
538 |
314 |
$29K |
| D0330 |
Panoramic radiographic image |
626 |
614 |
$28K |
| D1110 |
Prophylaxis - adult |
475 |
473 |
$26K |
| D0274 |
Bitewings - four radiographic images |
729 |
724 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
401 |
242 |
$20K |
| D2335 |
|
114 |
51 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
509 |
505 |
$6K |
| D0272 |
Bitewings - two radiographic images |
364 |
357 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
81 |
55 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
169 |
168 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
400 |
393 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
467 |
156 |
$3K |