| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,479 |
2,297 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
2,981 |
2,641 |
$74K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,477 |
504 |
$70K |
| D1110 |
Prophylaxis - adult |
1,810 |
1,377 |
$68K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
574 |
153 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,457 |
2,291 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,348 |
1,228 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,469 |
921 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
637 |
387 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,839 |
1,641 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
242 |
132 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,618 |
1,346 |
$18K |
| D1206 |
Topical application of fluoride varnish |
753 |
721 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
671 |
309 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
953 |
792 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
457 |
395 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
43 |
43 |
$3K |
| D9420 |
|
16 |
12 |
$1K |