| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,287 |
5,285 |
$271K |
| D0120 |
Periodic oral evaluation - established patient |
2,957 |
2,957 |
$195K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,790 |
1,790 |
$118K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,240 |
5,236 |
$99K |
| D1310 |
|
2,125 |
2,125 |
$96K |
| D1351 |
Sealant - per tooth |
1,266 |
462 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,128 |
3,585 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
411 |
267 |
$26K |
| D0272 |
Bitewings - two radiographic images |
2,080 |
2,078 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
429 |
254 |
$22K |
| D0603 |
|
1,412 |
1,412 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
284 |
284 |
$19K |
| D0274 |
Bitewings - four radiographic images |
772 |
772 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
343 |
330 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
858 |
856 |
$10K |
| D0350 |
|
960 |
518 |
$9K |
| D0601 |
|
413 |
413 |
$6K |
| D9430 |
|
85 |
83 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
24 |
$2K |