| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,416 |
8,281 |
$210K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,533 |
1,095 |
$197K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,074 |
418 |
$177K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,908 |
1,176 |
$169K |
| D1351 |
Sealant - per tooth |
7,618 |
1,526 |
$164K |
| D1206 |
Topical application of fluoride varnish |
10,219 |
10,053 |
$155K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,068 |
2,860 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
7,315 |
7,223 |
$134K |
| D9420 |
|
494 |
485 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,555 |
1,085 |
$100K |
| D0272 |
Bitewings - two radiographic images |
4,941 |
4,858 |
$81K |
| D1110 |
Prophylaxis - adult |
1,304 |
1,289 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
874 |
855 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,404 |
1,383 |
$31K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
232 |
131 |
$21K |
| D1354 |
|
2,456 |
753 |
$20K |
| D0240 |
|
1,265 |
676 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,473 |
1,428 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
856 |
353 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
166 |
165 |
$3K |
| D0274 |
Bitewings - four radiographic images |
39 |
39 |
$956.08 |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$825.18 |