| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,612 |
11,289 |
$477K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,908 |
2,448 |
$349K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,538 |
2,034 |
$302K |
| D0120 |
Periodic oral evaluation - established patient |
10,400 |
10,125 |
$292K |
| D1351 |
Sealant - per tooth |
2,937 |
1,463 |
$249K |
| D1206 |
Topical application of fluoride varnish |
9,191 |
8,954 |
$240K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,639 |
7,374 |
$173K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,129 |
1,712 |
$146K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,769 |
14,725 |
$135K |
| D0274 |
Bitewings - four radiographic images |
5,901 |
5,728 |
$105K |
| D0220 |
Intraoral - periapical first radiographic image |
16,526 |
15,924 |
$100K |
| D5110 |
|
235 |
228 |
$87K |
| D1110 |
Prophylaxis - adult |
1,579 |
1,557 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,049 |
880 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
2,849 |
2,729 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
547 |
485 |
$43K |
| D5120 |
|
95 |
95 |
$38K |
| D0330 |
Panoramic radiographic image |
1,700 |
1,647 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
627 |
619 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,258 |
1,235 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
300 |
269 |
$7K |
| D2950 |
|
31 |
24 |
$2K |
| D2332 |
|
13 |
12 |
$1K |
| D2140 |
|
13 |
12 |
$493.60 |