| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,889 |
8,887 |
$261K |
| D0120 |
Periodic oral evaluation - established patient |
7,238 |
7,237 |
$205K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,906 |
2,681 |
$166K |
| D0272 |
Bitewings - two radiographic images |
6,349 |
6,349 |
$122K |
| D0220 |
Intraoral - periapical first radiographic image |
9,436 |
9,359 |
$112K |
| D1206 |
Topical application of fluoride varnish |
4,061 |
4,061 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,444 |
8,313 |
$89K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
602 |
372 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,018 |
5,018 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
451 |
321 |
$55K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
693 |
444 |
$36K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
482 |
284 |
$33K |
| D1351 |
Sealant - per tooth |
973 |
339 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
734 |
734 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
417 |
405 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
281 |
281 |
$10K |
| D9110 |
|
152 |
148 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
159 |
102 |
$8K |
| D0274 |
Bitewings - four radiographic images |
190 |
190 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
32 |
$4K |
| D2140 |
|
65 |
53 |
$3K |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$1K |
| D1110 |
Prophylaxis - adult |
32 |
32 |
$1K |