| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,376 |
10,690 |
$258K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,319 |
317 |
$195K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,991 |
10,328 |
$190K |
| D0120 |
Periodic oral evaluation - established patient |
8,783 |
8,303 |
$177K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,842 |
717 |
$140K |
| D0240 |
|
5,711 |
2,600 |
$69K |
| D0330 |
Panoramic radiographic image |
1,152 |
1,124 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,306 |
2,160 |
$68K |
| D0272 |
Bitewings - two radiographic images |
4,653 |
4,422 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,519 |
1,472 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
532 |
525 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
3,516 |
3,382 |
$22K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
214 |
90 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,757 |
2,387 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
139 |
95 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
199 |
137 |
$13K |
| D0270 |
|
24 |
24 |
$122.50 |
| D1999 |
|
42 |
40 |
$0.00 |