| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,975 |
5,834 |
$303K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,537 |
8,361 |
$246K |
| D0120 |
Periodic oral evaluation - established patient |
7,405 |
7,251 |
$214K |
| D1110 |
Prophylaxis - adult |
2,183 |
2,132 |
$147K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,002 |
491 |
$117K |
| D1351 |
Sealant - per tooth |
2,386 |
704 |
$96K |
| D0274 |
Bitewings - four radiographic images |
2,014 |
1,973 |
$87K |
| D7240 |
Removal of impacted tooth - completely bony |
252 |
71 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
540 |
274 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
739 |
715 |
$42K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
193 |
98 |
$39K |
| D0330 |
Panoramic radiographic image |
404 |
396 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,257 |
1,114 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
213 |
103 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
393 |
370 |
$17K |
| D0272 |
Bitewings - two radiographic images |
474 |
471 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
606 |
581 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
235 |
155 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
19 |
13 |
$2K |
| D9941 |
|
16 |
16 |
$1K |
| D0190 |
|
39 |
38 |
$819.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
31 |
30 |
$810.00 |
| D1330 |
|
41 |
40 |
$574.00 |