| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,186 |
8,001 |
$289K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,208 |
523 |
$280K |
| D1206 |
Topical application of fluoride varnish |
9,176 |
8,973 |
$183K |
| D0350 |
|
4,880 |
4,779 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
4,056 |
3,967 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,086 |
2,018 |
$85K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,991 |
1,921 |
$63K |
| D0272 |
Bitewings - two radiographic images |
2,991 |
2,917 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,205 |
1,167 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
350 |
159 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,710 |
2,631 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
255 |
159 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
189 |
125 |
$24K |
| D0240 |
|
556 |
548 |
$15K |
| D0330 |
Panoramic radiographic image |
241 |
230 |
$12K |
| D1351 |
Sealant - per tooth |
220 |
85 |
$9K |
| D1110 |
Prophylaxis - adult |
153 |
140 |
$8K |
| D0190 |
|
490 |
482 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
179 |
175 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
149 |
144 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
270 |
250 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
20 |
12 |
$2K |
| D1354 |
|
68 |
27 |
$578.30 |
| D9219 |
|
14 |
14 |
$553.14 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$392.51 |