| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,046 |
10,867 |
$433K |
| D0120 |
Periodic oral evaluation - established patient |
10,870 |
10,685 |
$351K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,756 |
632 |
$313K |
| D1206 |
Topical application of fluoride varnish |
11,993 |
11,749 |
$293K |
| D1351 |
Sealant - per tooth |
5,702 |
1,436 |
$182K |
| D0272 |
Bitewings - two radiographic images |
5,027 |
4,937 |
$148K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,068 |
666 |
$106K |
| D1110 |
Prophylaxis - adult |
1,773 |
1,737 |
$94K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,099 |
715 |
$88K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,049 |
1,938 |
$78K |
| D0330 |
Panoramic radiographic image |
588 |
575 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
919 |
902 |
$41K |
| D0145 |
Oral evaluation for a patient under three years of age |
947 |
934 |
$34K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
280 |
156 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
339 |
186 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,067 |
1,050 |
$23K |
| D0240 |
|
1,243 |
638 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,201 |
1,144 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
207 |
207 |
$17K |
| D0274 |
Bitewings - four radiographic images |
312 |
302 |
$11K |
| D2940 |
|
45 |
27 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
184 |
94 |
$2K |
| D1330 |
|
71 |
71 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$460.13 |