| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,721 |
10,721 |
$372K |
| D0120 |
Periodic oral evaluation - established patient |
15,348 |
15,348 |
$353K |
| D1110 |
Prophylaxis - adult |
5,730 |
5,730 |
$282K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,375 |
16,375 |
$265K |
| D0272 |
Bitewings - two radiographic images |
7,401 |
7,401 |
$138K |
| D1351 |
Sealant - per tooth |
3,421 |
734 |
$100K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,173 |
719 |
$86K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,660 |
2,618 |
$83K |
| D0330 |
Panoramic radiographic image |
1,628 |
1,628 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
166 |
114 |
$17K |
| D2140 |
|
287 |
229 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
377 |
377 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
357 |
356 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
830 |
821 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
158 |
158 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$1K |