| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,330 |
8,270 |
$297K |
| D0120 |
Periodic oral evaluation - established patient |
11,845 |
11,721 |
$296K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,241 |
1,219 |
$287K |
| D1110 |
Prophylaxis - adult |
2,321 |
2,266 |
$119K |
| D1206 |
Topical application of fluoride varnish |
4,658 |
4,644 |
$110K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,318 |
7,223 |
$103K |
| D0272 |
Bitewings - two radiographic images |
3,629 |
3,604 |
$77K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,319 |
2,203 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,047 |
1,045 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
375 |
230 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,717 |
2,688 |
$35K |
| D1351 |
Sealant - per tooth |
544 |
178 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
214 |
209 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
162 |
99 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
768 |
766 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
126 |
126 |
$4K |
| D3120 |
|
55 |
26 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
39 |
$1K |
| D9420 |
|
12 |
12 |
$1K |