| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,307 |
8,307 |
$351K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,986 |
958 |
$261K |
| D0120 |
Periodic oral evaluation - established patient |
7,901 |
7,899 |
$224K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,431 |
1,028 |
$134K |
| D1110 |
Prophylaxis - adult |
1,987 |
1,987 |
$112K |
| D1206 |
Topical application of fluoride varnish |
2,906 |
2,906 |
$85K |
| D1351 |
Sealant - per tooth |
1,363 |
541 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,317 |
5,317 |
$74K |
| D0272 |
Bitewings - two radiographic images |
3,846 |
3,846 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,064 |
639 |
$62K |
| D0330 |
Panoramic radiographic image |
1,553 |
1,553 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,957 |
1,957 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
796 |
774 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,078 |
1,078 |
$31K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
276 |
199 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
166 |
150 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
423 |
421 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
570 |
569 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
496 |
489 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
62 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
29 |
29 |
$825.00 |
| D1999 |
|
38 |
35 |
$0.00 |