| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
21,148 |
21,085 |
$722K |
| D0120 |
Periodic oral evaluation - established patient |
26,632 |
26,572 |
$637K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,703 |
2,817 |
$606K |
| D1206 |
Topical application of fluoride varnish |
30,344 |
30,248 |
$589K |
| D1110 |
Prophylaxis - adult |
7,438 |
7,416 |
$343K |
| D0272 |
Bitewings - two radiographic images |
14,346 |
14,323 |
$301K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,287 |
978 |
$279K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,137 |
5,969 |
$191K |
| D0330 |
Panoramic radiographic image |
2,878 |
2,866 |
$149K |
| D1351 |
Sealant - per tooth |
3,905 |
1,205 |
$133K |
| D0274 |
Bitewings - four radiographic images |
4,194 |
4,183 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,553 |
2,547 |
$101K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
942 |
631 |
$93K |
| D7140 |
Extraction, erupted tooth or exposed root |
836 |
451 |
$81K |
| D0240 |
|
1,624 |
1,618 |
$59K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,580 |
1,579 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,174 |
1,169 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
1,016 |
1,011 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
150 |
150 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
87 |
43 |
$7K |
| D1354 |
|
370 |
120 |
$2K |