| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,893 |
5,860 |
$283K |
| D0120 |
Periodic oral evaluation - established patient |
2,978 |
2,959 |
$204K |
| D1310 |
|
3,806 |
3,791 |
$171K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,724 |
1,720 |
$119K |
| D1351 |
Sealant - per tooth |
2,278 |
696 |
$83K |
| D1206 |
Topical application of fluoride varnish |
3,391 |
3,364 |
$67K |
| D0145 |
Oral evaluation for a patient under three years of age |
955 |
952 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,957 |
4,996 |
$65K |
| D9430 |
|
1,573 |
1,464 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
748 |
463 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,235 |
1,164 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,122 |
2,113 |
$49K |
| D0272 |
Bitewings - two radiographic images |
3,527 |
3,498 |
$40K |
| D0603 |
|
2,456 |
2,447 |
$36K |
| D0350 |
|
2,936 |
1,463 |
$29K |
| D9993 |
|
515 |
515 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
445 |
259 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,749 |
1,694 |
$21K |
| D0601 |
|
956 |
952 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
216 |
148 |
$12K |
| D1354 |
|
1,198 |
366 |
$10K |
| D0340 |
|
83 |
83 |
$4K |
| D0330 |
Panoramic radiographic image |
138 |
138 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
29 |
24 |
$3K |
| D0274 |
Bitewings - four radiographic images |
165 |
165 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
96 |
96 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15 |
12 |
$1K |
| D0270 |
|
54 |
53 |
$265.00 |
| D1999 |
|
105 |
101 |
$46.00 |