| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,078 |
6,074 |
$267K |
| D1206 |
Topical application of fluoride varnish |
6,337 |
6,332 |
$197K |
| D0120 |
Periodic oral evaluation - established patient |
5,546 |
5,542 |
$138K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,905 |
1,081 |
$132K |
| D1351 |
Sealant - per tooth |
6,402 |
1,834 |
$126K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,660 |
2,582 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,169 |
832 |
$64K |
| D0603 |
|
3,215 |
3,206 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,860 |
2,859 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
4,321 |
4,313 |
$21K |
| D1353 |
|
1,817 |
458 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,973 |
3,963 |
$16K |
| D9920 |
|
554 |
537 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
214 |
149 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
231 |
229 |
$10K |
| D0274 |
Bitewings - four radiographic images |
821 |
820 |
$10K |
| D1110 |
Prophylaxis - adult |
184 |
184 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
170 |
170 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
174 |
174 |
$4K |
| D0602 |
|
399 |
399 |
$4K |
| D0601 |
|
216 |
216 |
$2K |
| D0270 |
|
24 |
24 |
$120.00 |