| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,231 |
13,231 |
$458K |
| D0120 |
Periodic oral evaluation - established patient |
17,292 |
17,292 |
$399K |
| D1110 |
Prophylaxis - adult |
6,938 |
6,938 |
$347K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,047 |
2,289 |
$319K |
| D1206 |
Topical application of fluoride varnish |
19,155 |
19,155 |
$311K |
| D0272 |
Bitewings - two radiographic images |
15,555 |
15,555 |
$288K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,051 |
5,020 |
$163K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,591 |
1,326 |
$127K |
| D0330 |
Panoramic radiographic image |
2,293 |
2,293 |
$110K |
| D0210 |
Intraoral - complete series of radiographic images |
1,450 |
1,450 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,758 |
1,758 |
$71K |
| D0240 |
|
3,426 |
2,044 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
753 |
552 |
$64K |
| D9248 |
|
912 |
907 |
$61K |
| D0145 |
Oral evaluation for a patient under three years of age |
870 |
870 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
768 |
766 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
191 |
173 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
924 |
921 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
71 |
56 |
$9K |
| D7111 |
|
27 |
13 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
14 |
12 |
$1K |