| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,755 |
3,755 |
$191K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,720 |
2,720 |
$179K |
| D1310 |
|
1,904 |
1,904 |
$86K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
703 |
286 |
$83K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
986 |
452 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,538 |
1,490 |
$61K |
| D1351 |
Sealant - per tooth |
1,606 |
460 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,975 |
2,969 |
$59K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
527 |
252 |
$52K |
| D1206 |
Topical application of fluoride varnish |
1,538 |
1,538 |
$48K |
| D2140 |
|
596 |
336 |
$32K |
| D0145 |
Oral evaluation for a patient under three years of age |
549 |
549 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
598 |
598 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
605 |
605 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,928 |
1,928 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,694 |
1,690 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
348 |
217 |
$20K |
| D0350 |
|
1,016 |
934 |
$17K |
| D0603 |
|
1,155 |
1,155 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
188 |
101 |
$13K |
| D0272 |
Bitewings - two radiographic images |
758 |
758 |
$9K |
| D1320 |
|
879 |
879 |
$9K |
| D0602 |
|
475 |
475 |
$7K |
| D0274 |
Bitewings - four radiographic images |
215 |
215 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
25 |
$2K |