| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,618 |
10,530 |
$298K |
| D0120 |
Periodic oral evaluation - established patient |
8,760 |
8,696 |
$231K |
| D1206 |
Topical application of fluoride varnish |
12,358 |
12,245 |
$204K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,235 |
3,193 |
$149K |
| D1351 |
Sealant - per tooth |
4,518 |
1,049 |
$128K |
| D1110 |
Prophylaxis - adult |
1,977 |
1,955 |
$75K |
| D0272 |
Bitewings - two radiographic images |
3,991 |
3,954 |
$75K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,600 |
1,466 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
4,440 |
4,363 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
580 |
423 |
$63K |
| D0330 |
Panoramic radiographic image |
992 |
983 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,215 |
3,176 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
442 |
299 |
$36K |
| D0274 |
Bitewings - four radiographic images |
856 |
848 |
$27K |
| D0145 |
Oral evaluation for a patient under three years of age |
214 |
214 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
131 |
128 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
42 |
40 |
$657.02 |