| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,364 |
5,364 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
5,442 |
5,442 |
$124K |
| D1206 |
Topical application of fluoride varnish |
6,778 |
6,778 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,058 |
2,083 |
$63K |
| D1110 |
Prophylaxis - adult |
1,177 |
1,177 |
$58K |
| D1351 |
Sealant - per tooth |
1,794 |
475 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
521 |
347 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,600 |
1,521 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
2,919 |
2,900 |
$37K |
| D0330 |
Panoramic radiographic image |
525 |
525 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
608 |
608 |
$25K |
| D0274 |
Bitewings - four radiographic images |
713 |
713 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
290 |
290 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
123 |
61 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
126 |
78 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
170 |
167 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
38 |
12 |
$4K |
| D0272 |
Bitewings - two radiographic images |
146 |
146 |
$3K |