| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
973 |
957 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
914 |
901 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
159 |
155 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
242 |
236 |
$15K |
| D1351 |
Sealant - per tooth |
618 |
126 |
$15K |
| D1206 |
Topical application of fluoride varnish |
942 |
921 |
$13K |
| D0272 |
Bitewings - two radiographic images |
470 |
458 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
672 |
641 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
213 |
207 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
100 |
59 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
535 |
512 |
$6K |
| D1110 |
Prophylaxis - adult |
105 |
101 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
35 |
17 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
165 |
155 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
191 |
188 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
16 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
27 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$225.36 |
| D1999 |
|
555 |
505 |
$0.00 |
| D0603 |
|
1,650 |
1,623 |
$0.00 |