| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
670 |
406 |
$58K |
| D1120 |
Prophylaxis - child |
1,988 |
1,958 |
$56K |
| D0272 |
Bitewings - two radiographic images |
2,539 |
2,507 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
2,362 |
2,329 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
635 |
355 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,447 |
2,416 |
$39K |
| D1351 |
Sealant - per tooth |
1,223 |
492 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
376 |
264 |
$23K |
| D1110 |
Prophylaxis - adult |
499 |
495 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
556 |
532 |
$11K |
| D0240 |
|
356 |
331 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
100 |
63 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
187 |
183 |
$5K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$684.00 |