| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,616 |
4,615 |
$179K |
| D0120 |
Periodic oral evaluation - established patient |
2,269 |
2,267 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,044 |
2,043 |
$132K |
| D1310 |
|
1,233 |
1,230 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,228 |
3,227 |
$52K |
| D9993 |
|
778 |
776 |
$39K |
| D1110 |
Prophylaxis - adult |
328 |
328 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,200 |
2,228 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,327 |
1,327 |
$17K |
| D0274 |
Bitewings - four radiographic images |
793 |
792 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
234 |
136 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
214 |
214 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
338 |
325 |
$13K |
| D0240 |
|
1,313 |
707 |
$12K |
| D1351 |
Sealant - per tooth |
402 |
121 |
$11K |
| D0272 |
Bitewings - two radiographic images |
822 |
821 |
$10K |
| D0603 |
|
647 |
647 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
184 |
183 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
100 |
54 |
$8K |
| D9430 |
|
152 |
151 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
71 |
49 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
27 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
164 |
163 |
$2K |
| D0330 |
Panoramic radiographic image |
43 |
43 |
$1K |
| D0601 |
|
69 |
69 |
$975.00 |
| D0602 |
|
34 |
34 |
$510.00 |
| D1999 |
|
461 |
430 |
$149.50 |