| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,792 |
6,614 |
$188K |
| D0120 |
Periodic oral evaluation - established patient |
7,256 |
7,051 |
$166K |
| D1206 |
Topical application of fluoride varnish |
6,731 |
6,376 |
$160K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
711 |
379 |
$56K |
| D1351 |
Sealant - per tooth |
1,456 |
400 |
$39K |
| D0272 |
Bitewings - two radiographic images |
2,840 |
2,774 |
$38K |
| D1110 |
Prophylaxis - adult |
897 |
845 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,309 |
1,267 |
$28K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
174 |
37 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
905 |
848 |
$22K |
| D1999 |
|
2,209 |
2,064 |
$20K |
| D0330 |
Panoramic radiographic image |
461 |
443 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
179 |
120 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
327 |
299 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
147 |
145 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
973 |
930 |
$6K |
| D0274 |
Bitewings - four radiographic images |
269 |
237 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
656 |
389 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
26 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
13 |
$2K |