| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,774 |
2,682 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
3,487 |
3,377 |
$92K |
| D0145 |
Oral evaluation for a patient under three years of age |
603 |
590 |
$78K |
| D1351 |
Sealant - per tooth |
2,432 |
498 |
$59K |
| D1110 |
Prophylaxis - adult |
1,011 |
980 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,549 |
3,443 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,141 |
2,898 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,774 |
1,708 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
3,147 |
3,015 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
384 |
240 |
$32K |
| D0274 |
Bitewings - four radiographic images |
819 |
795 |
$26K |
| D9248 |
|
169 |
154 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
513 |
423 |
$12K |
| D0330 |
Panoramic radiographic image |
137 |
137 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
182 |
176 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
37 |
26 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
30 |
29 |
$348.20 |
| D1330 |
|
69 |
64 |
$12.25 |
| D0603 |
|
4,593 |
4,495 |
$0.00 |
| D0602 |
|
31 |
31 |
$0.00 |