| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,198 |
4,189 |
$215K |
| D0120 |
Periodic oral evaluation - established patient |
1,963 |
1,962 |
$130K |
| D1310 |
|
2,476 |
2,467 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,538 |
1,531 |
$103K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,790 |
3,206 |
$63K |
| D1206 |
Topical application of fluoride varnish |
1,982 |
1,974 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
834 |
581 |
$55K |
| D0145 |
Oral evaluation for a patient under three years of age |
743 |
742 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,045 |
938 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
2,916 |
2,804 |
$35K |
| D1351 |
Sealant - per tooth |
819 |
247 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,863 |
1,861 |
$25K |
| D9920 |
|
206 |
201 |
$22K |
| D9430 |
|
657 |
641 |
$21K |
| D0603 |
|
1,404 |
1,400 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
307 |
235 |
$16K |
| D0602 |
|
1,037 |
1,032 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
234 |
166 |
$13K |
| D1320 |
|
1,147 |
1,145 |
$11K |
| D0350 |
|
1,241 |
699 |
$11K |
| D0272 |
Bitewings - two radiographic images |
696 |
696 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
54 |
40 |
$6K |
| D1354 |
|
396 |
187 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
46 |
37 |
$5K |
| D9610 |
|
42 |
12 |
$1K |
| D9995 |
|
16 |
16 |
$24.96 |