| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,863 |
2,748 |
$117K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
914 |
747 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
2,330 |
2,222 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
689 |
546 |
$62K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
199 |
158 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
754 |
716 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,668 |
1,631 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
807 |
619 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,530 |
1,511 |
$38K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
206 |
160 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,771 |
2,429 |
$31K |
| D1206 |
Topical application of fluoride varnish |
815 |
758 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,981 |
2,908 |
$19K |
| D1354 |
|
529 |
344 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
90 |
81 |
$10K |
| D0274 |
Bitewings - four radiographic images |
540 |
501 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
499 |
472 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
253 |
229 |
$6K |
| D1110 |
Prophylaxis - adult |
150 |
141 |
$6K |
| D0272 |
Bitewings - two radiographic images |
351 |
331 |
$3K |