| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,936 |
1,933 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
966 |
964 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
821 |
821 |
$56K |
| D1310 |
|
1,160 |
1,159 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,069 |
2,653 |
$50K |
| D1206 |
Topical application of fluoride varnish |
1,958 |
1,955 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
440 |
261 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,347 |
2,070 |
$28K |
| D0350 |
|
2,197 |
919 |
$21K |
| D1110 |
Prophylaxis - adult |
193 |
193 |
$17K |
| D0603 |
|
1,076 |
1,076 |
$16K |
| D1351 |
Sealant - per tooth |
397 |
115 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
317 |
283 |
$13K |
| D9110 |
|
195 |
188 |
$12K |
| D0272 |
Bitewings - two radiographic images |
915 |
913 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
148 |
95 |
$8K |
| D9430 |
|
208 |
182 |
$7K |
| D9993 |
|
90 |
90 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
67 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
48 |
48 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
187 |
187 |
$3K |
| D1320 |
|
171 |
169 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
29 |
$3K |
| D1354 |
|
17 |
17 |
$560.00 |