| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,168 |
9,167 |
$433K |
| D0120 |
Periodic oral evaluation - established patient |
8,723 |
8,723 |
$279K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,963 |
1,271 |
$236K |
| D1206 |
Topical application of fluoride varnish |
4,413 |
4,413 |
$145K |
| D1351 |
Sealant - per tooth |
1,671 |
791 |
$109K |
| D0272 |
Bitewings - two radiographic images |
4,984 |
4,983 |
$94K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,214 |
848 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,919 |
4,919 |
$76K |
| D1110 |
Prophylaxis - adult |
1,151 |
1,151 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,525 |
1,525 |
$50K |
| D0240 |
|
1,226 |
1,223 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
1,426 |
1,413 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,057 |
1,001 |
$17K |
| D0274 |
Bitewings - four radiographic images |
384 |
384 |
$12K |
| D0330 |
Panoramic radiographic image |
274 |
274 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
143 |
111 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
339 |
338 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
222 |
220 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
38 |
38 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
95 |
94 |
$1K |
| D1999 |
|
181 |
175 |
$0.00 |
| D3120 |
|
14 |
12 |
$0.00 |