| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,191 |
2,156 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
1,286 |
1,262 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
653 |
648 |
$43K |
| D1310 |
|
1,161 |
1,130 |
$42K |
| D9993 |
|
740 |
737 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,150 |
2,112 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,367 |
1,824 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
371 |
180 |
$25K |
| D1351 |
Sealant - per tooth |
742 |
227 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
428 |
386 |
$17K |
| D0603 |
|
868 |
853 |
$13K |
| D0274 |
Bitewings - four radiographic images |
571 |
558 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
202 |
107 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
152 |
72 |
$9K |
| D0272 |
Bitewings - two radiographic images |
704 |
698 |
$8K |
| D0350 |
|
987 |
388 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
101 |
101 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
581 |
549 |
$7K |
| D9430 |
|
167 |
159 |
$5K |
| D0602 |
|
40 |
40 |
$165.00 |
| D0601 |
|
18 |
17 |
$90.00 |
| D1330 |
|
380 |
352 |
$0.00 |