| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,650 |
3,637 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
4,924 |
4,899 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,270 |
4,250 |
$77K |
| D1110 |
Prophylaxis - adult |
1,722 |
1,714 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,043 |
651 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
747 |
446 |
$42K |
| D0330 |
Panoramic radiographic image |
837 |
830 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,873 |
1,868 |
$32K |
| D0274 |
Bitewings - four radiographic images |
740 |
730 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
201 |
148 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
227 |
158 |
$15K |
| D0601 |
|
1,459 |
1,459 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
361 |
340 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
591 |
589 |
$12K |
| D1206 |
Topical application of fluoride varnish |
478 |
470 |
$9K |
| D1330 |
|
1,593 |
1,593 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
95 |
75 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
106 |
87 |
$5K |
| D2330 |
|
20 |
12 |
$995.32 |
| D9110 |
|
13 |
13 |
$405.40 |
| D0602 |
|
24 |
24 |
$240.00 |
| D1310 |
|
15 |
15 |
$163.05 |
| D0603 |
|
12 |
12 |
$120.00 |