| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,983 |
9,756 |
$267K |
| D0120 |
Periodic oral evaluation - established patient |
11,651 |
11,383 |
$207K |
| D1206 |
Topical application of fluoride varnish |
15,048 |
14,679 |
$197K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,568 |
1,728 |
$149K |
| D1110 |
Prophylaxis - adult |
2,861 |
2,768 |
$87K |
| D1351 |
Sealant - per tooth |
4,945 |
1,406 |
$81K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,087 |
4,337 |
$80K |
| D0330 |
Panoramic radiographic image |
2,390 |
2,307 |
$80K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
739 |
283 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,196 |
3,111 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,733 |
2,667 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
5,597 |
5,379 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
880 |
478 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,494 |
1,457 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
758 |
576 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,944 |
1,897 |
$27K |
| D0145 |
Oral evaluation for a patient under three years of age |
988 |
961 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
596 |
579 |
$14K |
| D0240 |
|
618 |
609 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
85 |
85 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
38 |
14 |
$3K |
| D1354 |
|
53 |
24 |
$417.03 |