| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,995 |
1,992 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
539 |
278 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,632 |
1,631 |
$60K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
195 |
55 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,258 |
1,258 |
$33K |
| D1206 |
Topical application of fluoride varnish |
834 |
833 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
531 |
517 |
$26K |
| D0272 |
Bitewings - two radiographic images |
882 |
881 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
207 |
207 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
144 |
84 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
627 |
619 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
118 |
59 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
186 |
185 |
$12K |
| D1351 |
Sealant - per tooth |
180 |
58 |
$7K |
| D1110 |
Prophylaxis - adult |
105 |
105 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
345 |
320 |
$6K |
| D0330 |
Panoramic radiographic image |
36 |
36 |
$3K |
| D9248 |
|
13 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
81 |
80 |
$1K |