| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
613 |
609 |
$40K |
| D1120 |
Prophylaxis - child |
736 |
731 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
404 |
218 |
$27K |
| D1310 |
|
502 |
498 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
388 |
348 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
121 |
80 |
$13K |
| D1351 |
Sealant - per tooth |
358 |
137 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
496 |
490 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
183 |
182 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
125 |
125 |
$7K |
| D0603 |
|
499 |
496 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
94 |
65 |
$5K |
| D1206 |
Topical application of fluoride varnish |
201 |
200 |
$4K |
| D0272 |
Bitewings - two radiographic images |
266 |
264 |
$3K |
| D0350 |
|
228 |
200 |
$2K |
| D0240 |
|
183 |
100 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
18 |
15 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
14 |
$975.80 |