| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,094 |
5,087 |
$258K |
| D0120 |
Periodic oral evaluation - established patient |
3,625 |
3,619 |
$171K |
| D1206 |
Topical application of fluoride varnish |
5,050 |
5,016 |
$161K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
784 |
587 |
$111K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,520 |
1,443 |
$96K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
387 |
290 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
626 |
473 |
$66K |
| D1351 |
Sealant - per tooth |
1,612 |
610 |
$64K |
| D0272 |
Bitewings - two radiographic images |
2,125 |
2,122 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,004 |
1,002 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
2,098 |
2,033 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
250 |
186 |
$35K |
| D0603 |
|
5,444 |
5,435 |
$33K |
| D0145 |
Oral evaluation for a patient under three years of age |
600 |
599 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
369 |
365 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,109 |
1,051 |
$18K |
| D0330 |
Panoramic radiographic image |
270 |
269 |
$17K |
| D1330 |
|
5,716 |
5,703 |
$11K |
| D9248 |
|
88 |
86 |
$10K |
| D1354 |
|
272 |
94 |
$3K |
| D9310 |
|
14 |
14 |
$2K |