| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,004 |
10,934 |
$358K |
| D1206 |
Topical application of fluoride varnish |
11,088 |
11,026 |
$226K |
| D0120 |
Periodic oral evaluation - established patient |
9,036 |
8,990 |
$215K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,774 |
649 |
$191K |
| D0272 |
Bitewings - two radiographic images |
6,192 |
6,147 |
$100K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
969 |
479 |
$69K |
| D1110 |
Prophylaxis - adult |
1,063 |
1,058 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
693 |
408 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,057 |
3,019 |
$37K |
| D9248 |
|
417 |
400 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,124 |
1,110 |
$32K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,339 |
1,336 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
476 |
230 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
731 |
695 |
$21K |
| D1351 |
Sealant - per tooth |
530 |
205 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,136 |
1,101 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
405 |
398 |
$9K |
| D1354 |
|
323 |
155 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
19 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
76 |
76 |
$1K |
| D1999 |
|
104 |
103 |
$0.00 |