| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,084 |
3,709 |
$131K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
764 |
325 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
794 |
447 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,661 |
2,430 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,312 |
1,195 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,433 |
2,347 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,916 |
1,617 |
$41K |
| D0145 |
Oral evaluation for a patient under three years of age |
881 |
780 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,955 |
1,783 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,072 |
868 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,152 |
1,893 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
348 |
172 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,478 |
1,139 |
$18K |
| D1351 |
Sealant - per tooth |
626 |
190 |
$16K |
| D1110 |
Prophylaxis - adult |
169 |
165 |
$8K |
| D9920 |
|
117 |
105 |
$6K |
| D0330 |
Panoramic radiographic image |
90 |
90 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
251 |
238 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
16 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$2K |