| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,111 |
2,111 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,441 |
2,441 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
550 |
194 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,729 |
2,729 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
494 |
252 |
$30K |
| D0330 |
Panoramic radiographic image |
634 |
634 |
$29K |
| D1110 |
Prophylaxis - adult |
636 |
636 |
$27K |
| D0272 |
Bitewings - two radiographic images |
958 |
958 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
255 |
110 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
405 |
392 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
351 |
347 |
$10K |
| D0274 |
Bitewings - four radiographic images |
288 |
288 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
528 |
521 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
220 |
220 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
29 |
$5K |
| D7111 |
|
75 |
56 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
125 |
125 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
124 |
89 |
$874.20 |