| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,253 |
9,123 |
$313K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,707 |
977 |
$289K |
| D1206 |
Topical application of fluoride varnish |
9,950 |
9,811 |
$212K |
| D0120 |
Periodic oral evaluation - established patient |
7,454 |
7,372 |
$184K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,864 |
941 |
$111K |
| D1351 |
Sealant - per tooth |
2,803 |
794 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,086 |
547 |
$73K |
| D0330 |
Panoramic radiographic image |
1,679 |
1,656 |
$69K |
| D9248 |
|
810 |
746 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,014 |
590 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,099 |
2,056 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,809 |
1,675 |
$50K |
| D0272 |
Bitewings - two radiographic images |
2,580 |
2,527 |
$43K |
| D1110 |
Prophylaxis - adult |
998 |
986 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,450 |
1,166 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,357 |
1,307 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,944 |
1,867 |
$23K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
206 |
112 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
521 |
511 |
$12K |
| D0274 |
Bitewings - four radiographic images |
283 |
278 |
$7K |
| D7962 |
|
12 |
12 |
$2K |
| D1999 |
|
651 |
611 |
$0.00 |