| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,829 |
2,802 |
$143K |
| D0120 |
Periodic oral evaluation - established patient |
1,476 |
1,465 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,245 |
1,234 |
$83K |
| D1310 |
|
1,608 |
1,592 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,819 |
2,790 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,849 |
2,656 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
606 |
317 |
$40K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
313 |
147 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
622 |
250 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
825 |
745 |
$33K |
| D0145 |
Oral evaluation for a patient under three years of age |
433 |
427 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
354 |
182 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,494 |
1,478 |
$17K |
| D0603 |
|
1,011 |
999 |
$15K |
| D9430 |
|
399 |
392 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,031 |
1,001 |
$12K |
| D1351 |
Sealant - per tooth |
311 |
102 |
$11K |
| D0350 |
|
1,023 |
358 |
$9K |
| D0602 |
|
359 |
355 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
45 |
28 |
$4K |
| D0274 |
Bitewings - four radiographic images |
119 |
119 |
$3K |
| D7111 |
|
32 |
13 |
$2K |
| D9993 |
|
13 |
13 |
$780.00 |