| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,649 |
2,624 |
$132K |
| D1351 |
Sealant - per tooth |
3,646 |
706 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
1,675 |
1,656 |
$126K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,765 |
814 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,449 |
1,437 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,701 |
3,393 |
$61K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
645 |
154 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,547 |
2,522 |
$40K |
| D1110 |
Prophylaxis - adult |
327 |
326 |
$29K |
| D2394 |
|
278 |
90 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
488 |
487 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,721 |
1,703 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,777 |
1,710 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
125 |
40 |
$12K |
| D4910 |
|
143 |
143 |
$11K |
| D4341 |
|
122 |
33 |
$9K |
| D1206 |
Topical application of fluoride varnish |
500 |
497 |
$8K |
| D9430 |
|
229 |
228 |
$7K |
| D0350 |
|
786 |
242 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
68 |
24 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
60 |
58 |
$2K |