| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,072 |
12,816 |
$454K |
| D0120 |
Periodic oral evaluation - established patient |
12,876 |
12,621 |
$352K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,180 |
1,375 |
$323K |
| D0210 |
Intraoral - complete series of radiographic images |
3,711 |
3,658 |
$223K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,757 |
10,548 |
$213K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,553 |
3,351 |
$132K |
| D9248 |
|
1,059 |
969 |
$127K |
| D1206 |
Topical application of fluoride varnish |
4,797 |
4,687 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,213 |
873 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,213 |
735 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
823 |
641 |
$79K |
| D1110 |
Prophylaxis - adult |
1,427 |
1,398 |
$71K |
| D0272 |
Bitewings - two radiographic images |
2,320 |
2,276 |
$50K |
| D0145 |
Oral evaluation for a patient under three years of age |
800 |
782 |
$42K |
| D1351 |
Sealant - per tooth |
1,384 |
575 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,507 |
2,120 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
366 |
359 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
959 |
942 |
$13K |
| D0330 |
Panoramic radiographic image |
165 |
165 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
50 |
38 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
141 |
87 |
$931.50 |
| D0350 |
|
348 |
270 |
$0.00 |
| D9986 |
|
135 |
132 |
$0.00 |