| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,325 |
8,217 |
$224K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,510 |
12,341 |
$209K |
| D0120 |
Periodic oral evaluation - established patient |
11,770 |
11,605 |
$190K |
| D1110 |
Prophylaxis - adult |
4,290 |
4,227 |
$163K |
| D0330 |
Panoramic radiographic image |
1,668 |
1,644 |
$77K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
926 |
480 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,063 |
624 |
$56K |
| D0272 |
Bitewings - two radiographic images |
3,051 |
3,004 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,690 |
1,662 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
986 |
980 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
198 |
161 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
595 |
589 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
434 |
421 |
$10K |
| D1351 |
Sealant - per tooth |
275 |
101 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
642 |
634 |
$6K |
| D0240 |
|
195 |
194 |
$2K |
| D9310 |
|
12 |
12 |
$1K |
| D9630 |
|
14 |
14 |
$278.18 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
38 |
13 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
49 |
24 |
$0.00 |