| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,643 |
3,643 |
$189K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,571 |
1,571 |
$103K |
| D1310 |
|
2,060 |
2,060 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
1,211 |
1,211 |
$80K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,753 |
2,790 |
$55K |
| D1206 |
Topical application of fluoride varnish |
1,599 |
1,599 |
$49K |
| D0145 |
Oral evaluation for a patient under three years of age |
643 |
643 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
841 |
803 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
459 |
331 |
$31K |
| D1351 |
Sealant - per tooth |
772 |
264 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,049 |
1,998 |
$24K |
| D9430 |
|
759 |
741 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,635 |
1,635 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
353 |
286 |
$19K |
| D0350 |
|
2,127 |
963 |
$18K |
| D0603 |
|
1,183 |
1,183 |
$18K |
| D1354 |
|
1,330 |
501 |
$16K |
| D1320 |
|
1,558 |
1,558 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,124 |
1,124 |
$13K |
| D9920 |
|
102 |
102 |
$12K |
| D0602 |
|
686 |
686 |
$10K |
| D0330 |
Panoramic radiographic image |
218 |
218 |
$7K |
| D0340 |
|
91 |
91 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
108 |
108 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$1K |
| D9995 |
|
26 |
26 |
$76.74 |