| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,076 |
4,058 |
$146K |
| D0120 |
Periodic oral evaluation - established patient |
3,771 |
3,769 |
$94K |
| D1206 |
Topical application of fluoride varnish |
2,555 |
2,529 |
$55K |
| D0350 |
|
1,084 |
775 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,868 |
1,865 |
$40K |
| D1110 |
Prophylaxis - adult |
779 |
778 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,717 |
2,712 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
255 |
124 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,169 |
2,156 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
860 |
848 |
$27K |
| D1351 |
Sealant - per tooth |
757 |
235 |
$26K |
| D0240 |
|
1,112 |
1,111 |
$22K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
175 |
61 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
211 |
129 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
792 |
792 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
343 |
343 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
90 |
51 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
82 |
82 |
$3K |
| D0274 |
Bitewings - four radiographic images |
70 |
70 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
40 |
$2K |
| D9219 |
|
41 |
41 |
$2K |
| D0330 |
Panoramic radiographic image |
31 |
31 |
$2K |
| D1353 |
|
42 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
41 |
$1K |
| D0340 |
|
15 |
15 |
$914.59 |