| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,571 |
4,415 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
6,495 |
6,304 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,415 |
900 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,596 |
6,362 |
$92K |
| D0330 |
Panoramic radiographic image |
1,650 |
1,574 |
$72K |
| D1110 |
Prophylaxis - adult |
1,898 |
1,838 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,309 |
2,743 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,022 |
730 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,079 |
669 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,982 |
2,871 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,460 |
1,408 |
$32K |
| D1351 |
Sealant - per tooth |
1,179 |
315 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,038 |
945 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
283 |
126 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,434 |
1,310 |
$14K |
| D1206 |
Topical application of fluoride varnish |
920 |
894 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
470 |
434 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
86 |
67 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
50 |
42 |
$4K |
| D1999 |
|
518 |
461 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
239 |
183 |
$2K |
| D2330 |
|
35 |
28 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
56 |
56 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
13 |
$1K |