| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,276 |
12,276 |
$582K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,289 |
2,181 |
$381K |
| D0120 |
Periodic oral evaluation - established patient |
9,975 |
9,975 |
$320K |
| D1206 |
Topical application of fluoride varnish |
6,640 |
6,640 |
$220K |
| D1351 |
Sealant - per tooth |
2,418 |
1,153 |
$161K |
| D0272 |
Bitewings - two radiographic images |
6,375 |
6,373 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,235 |
3,235 |
$107K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,600 |
6,600 |
$102K |
| D0240 |
|
2,816 |
2,814 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,338 |
1,060 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
878 |
735 |
$71K |
| D1110 |
Prophylaxis - adult |
971 |
971 |
$62K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
372 |
324 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
2,038 |
2,022 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,404 |
1,294 |
$21K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
182 |
159 |
$19K |
| D0330 |
Panoramic radiographic image |
300 |
300 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
674 |
671 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
515 |
515 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
57 |
57 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
183 |
178 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$1K |