| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
719 |
636 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
417 |
357 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
859 |
771 |
$23K |
| D1351 |
Sealant - per tooth |
712 |
143 |
$22K |
| D1206 |
Topical application of fluoride varnish |
852 |
763 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
245 |
166 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
199 |
139 |
$13K |
| D1110 |
Prophylaxis - adult |
279 |
254 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
143 |
100 |
$12K |
| D0272 |
Bitewings - two radiographic images |
305 |
276 |
$6K |
| D0274 |
Bitewings - four radiographic images |
165 |
150 |
$6K |
| D0330 |
Panoramic radiographic image |
98 |
90 |
$4K |
| D1330 |
|
315 |
312 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
109 |
95 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
139 |
130 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
42 |
42 |
$867.74 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$360.32 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$191.52 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
15 |
$160.30 |
| D0603 |
|
91 |
91 |
$0.00 |