| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,129 |
9,886 |
$419K |
| D0120 |
Periodic oral evaluation - established patient |
9,260 |
9,003 |
$259K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,359 |
9,122 |
$246K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,958 |
2,803 |
$153K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,103 |
9,018 |
$134K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,016 |
935 |
$114K |
| D1351 |
Sealant - per tooth |
1,432 |
779 |
$93K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,512 |
1,238 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,324 |
1,175 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,820 |
2,781 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
10,222 |
9,881 |
$64K |
| D1354 |
|
1,540 |
1,029 |
$43K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
630 |
586 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
706 |
651 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
704 |
690 |
$13K |
| D0274 |
Bitewings - four radiographic images |
300 |
297 |
$6K |
| D0272 |
Bitewings - two radiographic images |
480 |
478 |
$5K |
| D1510 |
|
26 |
25 |
$2K |