| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,815 |
1,694 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,011 |
1,853 |
$54K |
| D1351 |
Sealant - per tooth |
479 |
331 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,358 |
1,264 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
290 |
233 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
239 |
200 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
128 |
106 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
565 |
532 |
$11K |
| D0274 |
Bitewings - four radiographic images |
695 |
633 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,713 |
1,546 |
$9K |
| D1206 |
Topical application of fluoride varnish |
364 |
333 |
$8K |
| D1110 |
Prophylaxis - adult |
246 |
234 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,445 |
1,282 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
170 |
127 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
226 |
211 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
295 |
285 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
54 |
46 |
$4K |
| D0272 |
Bitewings - two radiographic images |
417 |
373 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
135 |
116 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
51 |
42 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
32 |
$2K |
| D0270 |
|
12 |
12 |
$67.20 |