| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,460 |
8,743 |
$233K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,623 |
1,807 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
10,581 |
9,816 |
$178K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,538 |
1,352 |
$172K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,791 |
581 |
$168K |
| D1999 |
|
7,238 |
5,925 |
$124K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,988 |
8,345 |
$119K |
| D0272 |
Bitewings - two radiographic images |
6,672 |
6,151 |
$100K |
| D0330 |
Panoramic radiographic image |
1,748 |
1,623 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,852 |
3,272 |
$74K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,278 |
656 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
4,657 |
4,328 |
$48K |
| D1110 |
Prophylaxis - adult |
1,237 |
1,167 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,423 |
2,974 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,963 |
1,782 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
782 |
734 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
830 |
764 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
217 |
95 |
$13K |
| D1351 |
Sealant - per tooth |
249 |
90 |
$6K |