| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,866 |
4,837 |
$181K |
| D0120 |
Periodic oral evaluation - established patient |
3,035 |
3,013 |
$173K |
| D0350 |
|
20,398 |
6,086 |
$171K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,283 |
786 |
$153K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,004 |
1,995 |
$131K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,071 |
673 |
$106K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,242 |
1,916 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,139 |
4,772 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,107 |
727 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,792 |
4,762 |
$70K |
| D7140 |
Extraction, erupted tooth or exposed root |
999 |
658 |
$57K |
| D1351 |
Sealant - per tooth |
1,816 |
563 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
654 |
473 |
$35K |
| D1310 |
|
720 |
710 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,096 |
2,086 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,125 |
1,116 |
$24K |
| D0145 |
Oral evaluation for a patient under three years of age |
282 |
282 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,372 |
1,342 |
$16K |
| D0603 |
|
412 |
402 |
$6K |
| D0601 |
|
226 |
226 |
$3K |
| D0330 |
Panoramic radiographic image |
79 |
79 |
$2K |
| D9430 |
|
40 |
40 |
$1K |