| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,612 |
7,039 |
$211K |
| D1354 |
|
6,037 |
1,043 |
$208K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,292 |
342 |
$137K |
| D0120 |
Periodic oral evaluation - established patient |
6,310 |
5,872 |
$129K |
| D1206 |
Topical application of fluoride varnish |
5,469 |
5,009 |
$128K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,548 |
644 |
$84K |
| D0272 |
Bitewings - two radiographic images |
4,440 |
4,088 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,012 |
414 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,878 |
2,257 |
$62K |
| D0330 |
Panoramic radiographic image |
909 |
845 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,761 |
2,554 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,150 |
1,059 |
$32K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
136 |
58 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
122 |
55 |
$5K |
| D1351 |
Sealant - per tooth |
286 |
73 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
113 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
370 |
335 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
97 |
96 |
$2K |
| D1999 |
|
156 |
124 |
$2K |
| D2332 |
|
19 |
12 |
$2K |
| D1110 |
Prophylaxis - adult |
28 |
28 |
$1K |
| D0160 |
|
12 |
12 |
$960.00 |
| D2330 |
|
25 |
14 |
$944.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$403.00 |