| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,462 |
5,368 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,104 |
997 |
$164K |
| D0120 |
Periodic oral evaluation - established patient |
6,890 |
6,769 |
$156K |
| D1206 |
Topical application of fluoride varnish |
6,988 |
6,861 |
$129K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
778 |
328 |
$79K |
| D1351 |
Sealant - per tooth |
3,529 |
1,029 |
$78K |
| D0272 |
Bitewings - two radiographic images |
3,015 |
2,973 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
869 |
539 |
$49K |
| D1110 |
Prophylaxis - adult |
1,199 |
1,173 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
647 |
365 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,932 |
2,674 |
$30K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
375 |
192 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
243 |
118 |
$19K |
| D9310 |
|
610 |
597 |
$19K |
| D2331 |
|
132 |
56 |
$9K |
| D0274 |
Bitewings - four radiographic images |
248 |
239 |
$7K |
| D0330 |
Panoramic radiographic image |
147 |
145 |
$7K |
| D2330 |
|
148 |
93 |
$7K |
| D9420 |
|
184 |
181 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
309 |
304 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
100 |
100 |
$3K |
| D1999 |
|
1,005 |
967 |
$0.00 |