| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,790 |
6,692 |
$288K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,072 |
551 |
$288K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,166 |
1,128 |
$226K |
| D0120 |
Periodic oral evaluation - established patient |
7,970 |
6,795 |
$192K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,628 |
7,348 |
$177K |
| D1351 |
Sealant - per tooth |
5,308 |
1,426 |
$161K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,769 |
2,284 |
$125K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,155 |
457 |
$95K |
| D1354 |
|
1,764 |
507 |
$91K |
| D0272 |
Bitewings - two radiographic images |
3,476 |
2,935 |
$85K |
| D1110 |
Prophylaxis - adult |
1,300 |
1,080 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
675 |
378 |
$60K |
| D0330 |
Panoramic radiographic image |
840 |
721 |
$47K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
387 |
147 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
998 |
849 |
$34K |
| D0240 |
|
516 |
418 |
$10K |
| D0274 |
Bitewings - four radiographic images |
212 |
173 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
73 |
$7K |
| D1206 |
Topical application of fluoride varnish |
308 |
277 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
346 |
262 |
$6K |
| D9630 |
|
184 |
164 |
$5K |
| D9420 |
|
139 |
104 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
124 |
105 |
$4K |
| D9310 |
|
15 |
12 |
$825.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$412.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
41 |
13 |
$404.80 |
| D1999 |
|
950 |
732 |
$0.00 |