| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,013 |
2,978 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,275 |
3,247 |
$72K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
704 |
242 |
$68K |
| D1206 |
Topical application of fluoride varnish |
3,138 |
3,085 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
432 |
218 |
$27K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
319 |
108 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
615 |
599 |
$17K |
| D0272 |
Bitewings - two radiographic images |
965 |
955 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
171 |
79 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
118 |
63 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
498 |
490 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
122 |
118 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
314 |
245 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$287.80 |