| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,997 |
1,994 |
$96K |
| D1351 |
Sealant - per tooth |
2,330 |
625 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,199 |
1,198 |
$79K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
844 |
361 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
920 |
868 |
$37K |
| D1310 |
|
1,012 |
1,011 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
552 |
264 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
505 |
505 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,211 |
1,409 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,860 |
1,858 |
$30K |
| D0145 |
Oral evaluation for a patient under three years of age |
237 |
237 |
$14K |
| D2140 |
|
245 |
140 |
$13K |
| D0603 |
|
1,002 |
1,001 |
$12K |
| D0272 |
Bitewings - two radiographic images |
790 |
789 |
$9K |
| D0350 |
|
958 |
402 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
76 |
42 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
131 |
44 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
669 |
662 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
156 |
155 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
70 |
39 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
14 |
$2K |
| D2160 |
|
20 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
70 |
70 |
$1K |