| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,648 |
5,547 |
$280K |
| D0120 |
Periodic oral evaluation - established patient |
8,990 |
8,895 |
$256K |
| D1120 |
Prophylaxis - child |
4,493 |
4,463 |
$163K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,285 |
3,301 |
$143K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,711 |
5,630 |
$116K |
| D0330 |
Panoramic radiographic image |
1,954 |
1,933 |
$107K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,017 |
711 |
$106K |
| D0272 |
Bitewings - two radiographic images |
4,690 |
4,646 |
$102K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,245 |
756 |
$83K |
| D2140 |
|
912 |
567 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
602 |
400 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,472 |
1,458 |
$37K |
| D1351 |
Sealant - per tooth |
1,080 |
331 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
327 |
208 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
281 |
260 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
973 |
892 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
420 |
406 |
$6K |
| D9248 |
|
33 |
26 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
39 |
39 |
$2K |
| D9997 |
|
59 |
45 |
$1K |