| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,035 |
3,944 |
$195K |
| D0120 |
Periodic oral evaluation - established patient |
6,770 |
6,644 |
$185K |
| D1120 |
Prophylaxis - child |
5,102 |
5,027 |
$176K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,561 |
831 |
$131K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,384 |
5,288 |
$106K |
| D0210 |
Intraoral - complete series of radiographic images |
1,601 |
1,578 |
$94K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
926 |
548 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,270 |
1,230 |
$57K |
| D0272 |
Bitewings - two radiographic images |
2,307 |
2,247 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,228 |
1,205 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
252 |
138 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,460 |
1,398 |
$21K |
| D1351 |
Sealant - per tooth |
697 |
229 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,574 |
1,007 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
147 |
108 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
290 |
275 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
129 |
62 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
217 |
217 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
133 |
127 |
$3K |
| D0274 |
Bitewings - four radiographic images |
14 |
13 |
$411.60 |