| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,466 |
8,442 |
$239K |
| D1110 |
Prophylaxis - adult |
4,425 |
4,406 |
$220K |
| D1120 |
Prophylaxis - child |
5,542 |
5,532 |
$202K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,961 |
1,136 |
$187K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,946 |
5,933 |
$123K |
| D0272 |
Bitewings - two radiographic images |
4,935 |
4,911 |
$107K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,648 |
2,535 |
$97K |
| D1351 |
Sealant - per tooth |
3,121 |
1,266 |
$93K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
447 |
206 |
$63K |
| D2160 |
|
472 |
313 |
$56K |
| D1206 |
Topical application of fluoride varnish |
2,037 |
2,033 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
632 |
623 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,496 |
1,465 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
196 |
196 |
$8K |
| D0330 |
Panoramic radiographic image |
31 |
31 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$1K |
| D2140 |
|
17 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
92 |
65 |
$708.36 |