| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,142 |
5,948 |
$166K |
| D0120 |
Periodic oral evaluation - established patient |
5,587 |
5,413 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,295 |
879 |
$134K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,049 |
2,769 |
$134K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,722 |
6,485 |
$111K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
567 |
434 |
$47K |
| D1351 |
Sealant - per tooth |
1,291 |
383 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,535 |
1,494 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
595 |
572 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,566 |
1,452 |
$23K |
| D1110 |
Prophylaxis - adult |
528 |
518 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
246 |
173 |
$16K |
| D0240 |
|
758 |
381 |
$12K |
| D0330 |
Panoramic radiographic image |
210 |
210 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
53 |
43 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
154 |
152 |
$6K |
| D0274 |
Bitewings - four radiographic images |
105 |
105 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
251 |
164 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
35 |
28 |
$646.17 |
| D1206 |
Topical application of fluoride varnish |
28 |
28 |
$419.50 |
| D1310 |
|
236 |
224 |
$0.00 |
| D1330 |
|
238 |
225 |
$0.00 |