| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,450 |
5,369 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
5,793 |
5,700 |
$165K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,554 |
6,448 |
$136K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,449 |
1,044 |
$128K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,310 |
2,157 |
$91K |
| D1351 |
Sealant - per tooth |
2,940 |
825 |
$88K |
| D0272 |
Bitewings - two radiographic images |
3,028 |
2,977 |
$67K |
| D1110 |
Prophylaxis - adult |
1,227 |
1,200 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
703 |
485 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
640 |
511 |
$45K |
| D0145 |
Oral evaluation for a patient under three years of age |
553 |
552 |
$28K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
163 |
134 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,156 |
1,106 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
387 |
362 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
36 |
36 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
14 |
13 |
$2K |