| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,084 |
2,057 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
2,382 |
2,339 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,784 |
2,723 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
430 |
210 |
$43K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
310 |
100 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
267 |
121 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
554 |
536 |
$28K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
154 |
55 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
289 |
133 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,458 |
407 |
$19K |
| D1110 |
Prophylaxis - adult |
342 |
340 |
$19K |
| D0272 |
Bitewings - two radiographic images |
744 |
729 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
731 |
711 |
$13K |
| D9310 |
|
83 |
80 |
$4K |
| D9420 |
|
41 |
39 |
$3K |
| D0330 |
Panoramic radiographic image |
46 |
45 |
$3K |
| D1351 |
Sealant - per tooth |
79 |
16 |
$2K |