| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
10,017 |
2,410 |
$289K |
| D1206 |
Topical application of fluoride varnish |
6,311 |
6,265 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
5,382 |
5,363 |
$125K |
| D1120 |
Prophylaxis - child |
4,513 |
4,497 |
$123K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,056 |
2,009 |
$102K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,531 |
952 |
$100K |
| D1110 |
Prophylaxis - adult |
2,412 |
2,412 |
$97K |
| D0274 |
Bitewings - four radiographic images |
2,471 |
2,469 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
976 |
619 |
$74K |
| D0272 |
Bitewings - two radiographic images |
3,279 |
3,270 |
$62K |
| D0330 |
Panoramic radiographic image |
1,263 |
1,261 |
$55K |
| D2160 |
|
659 |
513 |
$51K |
| D2335 |
|
434 |
204 |
$34K |
| D1330 |
|
5,231 |
5,222 |
$26K |
| D2161 |
|
301 |
250 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
178 |
131 |
$19K |
| D0603 |
|
1,845 |
1,844 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,610 |
1,585 |
$15K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
154 |
123 |
$14K |
| D2140 |
|
258 |
194 |
$14K |
| D0601 |
|
1,186 |
1,184 |
$12K |
| D2332 |
|
149 |
96 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
364 |
364 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
735 |
684 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
445 |
438 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
305 |
304 |
$7K |
| D1510 |
|
14 |
14 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
34 |
$2K |
| D1320 |
|
100 |
100 |
$2K |
| D0602 |
|
144 |
144 |
$1K |
| D9110 |
|
13 |
13 |
$473.82 |