| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,370 |
3,353 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
2,314 |
2,302 |
$98K |
| D9993 |
|
1,380 |
1,370 |
$86K |
| D1310 |
|
1,381 |
1,377 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
842 |
463 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
892 |
889 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,369 |
3,351 |
$37K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
257 |
164 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
719 |
546 |
$28K |
| D1351 |
Sealant - per tooth |
1,049 |
295 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,518 |
1,509 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
237 |
236 |
$14K |
| D0603 |
|
800 |
797 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
96 |
61 |
$9K |
| D0601 |
|
433 |
433 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
47 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
38 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
731 |
401 |
$3K |
| D9430 |
|
88 |
84 |
$3K |
| D0240 |
|
261 |
145 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
142 |
139 |
$2K |
| D0330 |
Panoramic radiographic image |
45 |
45 |
$1K |
| D1999 |
|
31 |
30 |
$782.00 |
| D0274 |
Bitewings - four radiographic images |
31 |
31 |
$669.60 |
| D0210 |
Intraoral - complete series of radiographic images |
19 |
18 |
$576.00 |
| D0602 |
|
28 |
28 |
$405.00 |
| D0350 |
|
21 |
12 |
$220.80 |