| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,636 |
7,218 |
$289K |
| D0120 |
Periodic oral evaluation - established patient |
9,734 |
9,181 |
$286K |
| D1354 |
|
15,789 |
3,074 |
$226K |
| D1110 |
Prophylaxis - adult |
4,116 |
3,836 |
$203K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,459 |
7,956 |
$178K |
| D1351 |
Sealant - per tooth |
6,347 |
2,241 |
$177K |
| D0330 |
Panoramic radiographic image |
2,694 |
2,603 |
$166K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,676 |
866 |
$156K |
| D0272 |
Bitewings - two radiographic images |
6,042 |
5,663 |
$135K |
| D0220 |
Intraoral - periapical first radiographic image |
6,733 |
6,281 |
$100K |
| D1206 |
Topical application of fluoride varnish |
3,024 |
2,848 |
$81K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,271 |
5,868 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,122 |
1,036 |
$55K |
| D0145 |
Oral evaluation for a patient under three years of age |
975 |
922 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
675 |
343 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,299 |
1,192 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
365 |
227 |
$45K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
143 |
64 |
$31K |
| D9248 |
|
107 |
103 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
177 |
124 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
113 |
108 |
$2K |
| D3120 |
|
1,053 |
581 |
$0.00 |
| D0603 |
|
551 |
547 |
$0.00 |
| D0602 |
|
107 |
106 |
$0.00 |
| D1999 |
|
1,484 |
1,326 |
$0.00 |
| D0350 |
|
314 |
182 |
$0.00 |