| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,166 |
7,166 |
$306K |
| D0120 |
Periodic oral evaluation - established patient |
6,036 |
6,036 |
$164K |
| D1206 |
Topical application of fluoride varnish |
3,842 |
3,842 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
755 |
445 |
$69K |
| D0272 |
Bitewings - two radiographic images |
3,489 |
3,489 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,664 |
3,664 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,202 |
1,202 |
$36K |
| D1110 |
Prophylaxis - adult |
611 |
611 |
$33K |
| D1351 |
Sealant - per tooth |
603 |
254 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
639 |
282 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
701 |
683 |
$14K |
| D0330 |
Panoramic radiographic image |
204 |
204 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
90 |
88 |
$7K |
| D9310 |
|
52 |
52 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
29 |
12 |
$3K |
| D7962 |
|
15 |
15 |
$3K |
| D7961 |
|
15 |
15 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
78 |
78 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
68 |
67 |
$884.18 |
| D9430 |
|
32 |
32 |
$656.00 |
| D0274 |
Bitewings - four radiographic images |
24 |
24 |
$654.24 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$342.20 |
| D1330 |
|
80 |
80 |
$0.00 |
| D0603 |
|
43 |
43 |
$0.00 |
| D0602 |
|
16 |
16 |
$0.00 |