| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,012 |
3,994 |
$208K |
| D0120 |
Periodic oral evaluation - established patient |
1,997 |
1,992 |
$141K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,258 |
1,251 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,935 |
3,919 |
$81K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,531 |
3,329 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
747 |
308 |
$50K |
| D1310 |
|
964 |
959 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
946 |
896 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,195 |
2,187 |
$26K |
| D0145 |
Oral evaluation for a patient under three years of age |
252 |
252 |
$18K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
86 |
42 |
$10K |
| D0603 |
|
403 |
403 |
$6K |
| D0274 |
Bitewings - four radiographic images |
277 |
277 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
91 |
62 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
393 |
391 |
$5K |
| D0601 |
|
263 |
259 |
$4K |
| D9430 |
|
117 |
117 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
32 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$490.00 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$420.00 |