| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,600 |
1,590 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
840 |
409 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,178 |
1,177 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
495 |
220 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
658 |
605 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,451 |
1,429 |
$20K |
| D1351 |
Sealant - per tooth |
890 |
228 |
$19K |
| D1206 |
Topical application of fluoride varnish |
1,594 |
1,586 |
$18K |
| D0330 |
Panoramic radiographic image |
442 |
437 |
$11K |
| D9430 |
|
365 |
352 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
193 |
83 |
$10K |
| D0272 |
Bitewings - two radiographic images |
858 |
853 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
214 |
214 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
161 |
160 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
514 |
498 |
$5K |
| D2330 |
|
29 |
15 |
$2K |
| D0274 |
Bitewings - four radiographic images |
70 |
70 |
$1K |