| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,455 |
2,292 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
2,137 |
2,015 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
633 |
307 |
$43K |
| D1206 |
Topical application of fluoride varnish |
2,256 |
2,109 |
$40K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
282 |
115 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
629 |
575 |
$24K |
| D0272 |
Bitewings - two radiographic images |
967 |
914 |
$21K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
243 |
100 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
221 |
122 |
$11K |
| D0330 |
Panoramic radiographic image |
139 |
137 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
224 |
202 |
$7K |
| D1351 |
Sealant - per tooth |
239 |
77 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
58 |
46 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
255 |
235 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
119 |
112 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
25 |
$963.16 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$733.61 |
| D0274 |
Bitewings - four radiographic images |
15 |
13 |
$508.38 |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
13 |
$153.60 |