| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,775 |
3,690 |
$150K |
| D0120 |
Periodic oral evaluation - established patient |
4,392 |
4,280 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
921 |
512 |
$115K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,905 |
4,782 |
$113K |
| D1110 |
Prophylaxis - adult |
1,085 |
1,052 |
$68K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,592 |
1,518 |
$58K |
| D0272 |
Bitewings - two radiographic images |
1,664 |
1,631 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
529 |
348 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
486 |
273 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,156 |
1,123 |
$44K |
| D9110 |
|
584 |
559 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
452 |
446 |
$30K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
178 |
111 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
379 |
359 |
$15K |
| D1351 |
Sealant - per tooth |
337 |
90 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
39 |
15 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
335 |
330 |
$6K |
| D0330 |
Panoramic radiographic image |
65 |
65 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
441 |
441 |
$2K |