| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,664 |
9,545 |
$332K |
| D1206 |
Topical application of fluoride varnish |
10,697 |
10,561 |
$228K |
| D0120 |
Periodic oral evaluation - established patient |
9,016 |
8,912 |
$187K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,908 |
1,123 |
$175K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,638 |
2,501 |
$92K |
| D1351 |
Sealant - per tooth |
2,550 |
865 |
$85K |
| D0272 |
Bitewings - two radiographic images |
3,327 |
3,293 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,381 |
1,350 |
$44K |
| D1110 |
Prophylaxis - adult |
720 |
707 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
452 |
302 |
$35K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
157 |
81 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,668 |
1,623 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
256 |
155 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
415 |
351 |
$17K |
| D1354 |
|
678 |
250 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
448 |
437 |
$12K |
| D0274 |
Bitewings - four radiographic images |
271 |
262 |
$8K |
| D9630 |
|
351 |
346 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
536 |
412 |
$6K |
| D0330 |
Panoramic radiographic image |
51 |
51 |
$3K |
| D3120 |
|
34 |
27 |
$625.94 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$261.95 |