| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,211 |
9,211 |
$460K |
| D0120 |
Periodic oral evaluation - established patient |
15,339 |
15,339 |
$356K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,814 |
2,337 |
$302K |
| D1120 |
Prophylaxis - child |
8,089 |
8,089 |
$282K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,551 |
1,903 |
$251K |
| D0272 |
Bitewings - two radiographic images |
12,789 |
12,789 |
$235K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,741 |
13,741 |
$224K |
| D0330 |
Panoramic radiographic image |
4,112 |
4,112 |
$199K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,345 |
744 |
$177K |
| D1351 |
Sealant - per tooth |
5,506 |
1,579 |
$165K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,528 |
4,426 |
$146K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,512 |
928 |
$134K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,226 |
799 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,100 |
2,100 |
$85K |
| D0140 |
Limited oral evaluation - problem focused |
1,749 |
1,730 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
409 |
362 |
$49K |
| D9920 |
|
888 |
873 |
$46K |
| D2140 |
|
550 |
378 |
$32K |
| D1206 |
Topical application of fluoride varnish |
842 |
842 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
801 |
791 |
$10K |
| D2332 |
|
80 |
49 |
$8K |
| D2160 |
|
82 |
66 |
$8K |
| D0240 |
|
196 |
196 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
44 |
37 |
$4K |
| D2330 |
|
30 |
24 |
$2K |
| D0274 |
Bitewings - four radiographic images |
27 |
27 |
$724.66 |