| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,588 |
5,562 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
7,654 |
7,617 |
$179K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,030 |
537 |
$132K |
| D1206 |
Topical application of fluoride varnish |
7,027 |
6,998 |
$129K |
| D1110 |
Prophylaxis - adult |
1,988 |
1,976 |
$86K |
| D0272 |
Bitewings - two radiographic images |
2,534 |
2,514 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,327 |
1,288 |
$42K |
| D1351 |
Sealant - per tooth |
856 |
292 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,681 |
1,671 |
$23K |
| D0330 |
Panoramic radiographic image |
380 |
380 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
522 |
522 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
176 |
117 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
124 |
38 |
$15K |
| D0274 |
Bitewings - four radiographic images |
424 |
423 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
804 |
793 |
$10K |
| D0240 |
|
227 |
226 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
156 |
155 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
12 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
70 |
70 |
$2K |