| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,852 |
6,852 |
$235K |
| D0120 |
Periodic oral evaluation - established patient |
5,092 |
5,092 |
$118K |
| D1206 |
Topical application of fluoride varnish |
7,153 |
7,153 |
$116K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,430 |
1,430 |
$73K |
| D7140 |
Extraction, erupted tooth or exposed root |
663 |
299 |
$69K |
| D0272 |
Bitewings - two radiographic images |
3,238 |
3,238 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,470 |
1,470 |
$59K |
| D1110 |
Prophylaxis - adult |
1,169 |
1,169 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,427 |
1,376 |
$45K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
302 |
128 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
932 |
927 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,510 |
2,484 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,436 |
1,336 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
314 |
198 |
$25K |
| D0330 |
Panoramic radiographic image |
522 |
522 |
$24K |
| D1351 |
Sealant - per tooth |
629 |
195 |
$18K |
| D0274 |
Bitewings - four radiographic images |
461 |
461 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
104 |
79 |
$11K |
| D9248 |
|
122 |
119 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
384 |
384 |
$6K |