| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,462 |
9,819 |
$284K |
| D0120 |
Periodic oral evaluation - established patient |
9,473 |
9,063 |
$181K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,565 |
1,106 |
$176K |
| D1999 |
|
8,773 |
7,595 |
$159K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,342 |
1,685 |
$157K |
| D0330 |
Panoramic radiographic image |
3,467 |
3,155 |
$139K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,912 |
8,390 |
$126K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,216 |
4,763 |
$118K |
| D1206 |
Topical application of fluoride varnish |
5,160 |
4,780 |
$116K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,146 |
874 |
$97K |
| D0272 |
Bitewings - two radiographic images |
5,505 |
5,107 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,589 |
1,122 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,568 |
3,212 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,568 |
2,544 |
$72K |
| D1351 |
Sealant - per tooth |
2,875 |
783 |
$62K |
| D1110 |
Prophylaxis - adult |
1,676 |
1,606 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,814 |
1,684 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
4,842 |
4,341 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,050 |
983 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
940 |
860 |
$20K |
| D1354 |
|
92 |
45 |
$2K |
| D2330 |
|
18 |
14 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
14 |
14 |
$1K |