| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,490 |
9,490 |
$332K |
| D0120 |
Periodic oral evaluation - established patient |
12,703 |
12,703 |
$299K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,811 |
1,947 |
$292K |
| D1110 |
Prophylaxis - adult |
4,428 |
4,428 |
$222K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,049 |
1,570 |
$187K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,827 |
1,388 |
$157K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,152 |
5,042 |
$151K |
| D1206 |
Topical application of fluoride varnish |
7,464 |
7,464 |
$125K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,319 |
7,319 |
$118K |
| D0272 |
Bitewings - two radiographic images |
5,710 |
5,710 |
$108K |
| D0140 |
Limited oral evaluation - problem focused |
2,299 |
2,291 |
$88K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,116 |
811 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,538 |
1,538 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,389 |
1,389 |
$39K |
| D2140 |
|
592 |
453 |
$36K |
| D0145 |
Oral evaluation for a patient under three years of age |
629 |
629 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,090 |
1,081 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
97 |
79 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
70 |
56 |
$9K |
| D2330 |
|
114 |
74 |
$8K |
| D1351 |
Sealant - per tooth |
196 |
68 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
67 |
62 |
$5K |
| D9310 |
|
44 |
44 |
$3K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$754.10 |