| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,855 |
6,752 |
$234K |
| D0120 |
Periodic oral evaluation - established patient |
7,780 |
7,676 |
$211K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,559 |
630 |
$209K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,660 |
1,635 |
$194K |
| D1351 |
Sealant - per tooth |
6,902 |
1,399 |
$179K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,867 |
948 |
$170K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,140 |
6,294 |
$157K |
| D1206 |
Topical application of fluoride varnish |
8,664 |
8,547 |
$120K |
| D1110 |
Prophylaxis - adult |
1,866 |
1,842 |
$95K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,381 |
3,141 |
$84K |
| D0272 |
Bitewings - two radiographic images |
4,136 |
4,067 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,146 |
762 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
7,405 |
7,078 |
$74K |
| D0274 |
Bitewings - four radiographic images |
1,822 |
1,801 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
901 |
885 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
480 |
267 |
$23K |
| D0330 |
Panoramic radiographic image |
621 |
611 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
528 |
507 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
94 |
34 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
116 |
116 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
100 |
99 |
$1K |
| D0602 |
|
1,555 |
1,532 |
$0.00 |
| D0603 |
|
9,352 |
9,219 |
$0.00 |