| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,451 |
5,308 |
$166K |
| D0120 |
Periodic oral evaluation - established patient |
7,744 |
7,542 |
$165K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,420 |
839 |
$156K |
| D1206 |
Topical application of fluoride varnish |
7,942 |
7,738 |
$134K |
| D1110 |
Prophylaxis - adult |
2,247 |
2,190 |
$102K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,141 |
765 |
$68K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,293 |
2,062 |
$61K |
| D0272 |
Bitewings - two radiographic images |
2,596 |
2,522 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
643 |
394 |
$42K |
| D1351 |
Sealant - per tooth |
1,701 |
497 |
$41K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
322 |
82 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,045 |
1,013 |
$32K |
| D0330 |
Panoramic radiographic image |
475 |
468 |
$23K |
| D9248 |
|
151 |
136 |
$20K |
| D9310 |
|
407 |
391 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
780 |
736 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
232 |
232 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
49 |
14 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
25 |
$762.50 |