| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,787 |
15,769 |
$542K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,547 |
4,326 |
$526K |
| D0120 |
Periodic oral evaluation - established patient |
17,597 |
16,597 |
$457K |
| D1206 |
Topical application of fluoride varnish |
19,916 |
18,662 |
$257K |
| D0272 |
Bitewings - two radiographic images |
7,931 |
7,366 |
$155K |
| D1110 |
Prophylaxis - adult |
2,984 |
2,835 |
$144K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,385 |
853 |
$113K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,819 |
3,262 |
$87K |
| D1351 |
Sealant - per tooth |
2,941 |
738 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,874 |
1,720 |
$55K |
| D0330 |
Panoramic radiographic image |
839 |
795 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
309 |
217 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
522 |
267 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
1,256 |
1,169 |
$21K |
| D0274 |
Bitewings - four radiographic images |
545 |
520 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,258 |
1,122 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
64 |
54 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
43 |
42 |
$3K |
| D0601 |
|
10,420 |
9,916 |
$0.00 |
| D0603 |
|
13,302 |
12,670 |
$0.00 |
| D0602 |
|
250 |
243 |
$0.00 |