| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,762 |
7,649 |
$206K |
| D0120 |
Periodic oral evaluation - established patient |
6,121 |
5,475 |
$144K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,394 |
615 |
$123K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,040 |
6,920 |
$102K |
| D0272 |
Bitewings - two radiographic images |
7,992 |
6,096 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,579 |
2,127 |
$63K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,668 |
2,062 |
$32K |
| D0330 |
Panoramic radiographic image |
1,123 |
814 |
$30K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
378 |
115 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
474 |
166 |
$23K |
| D1351 |
Sealant - per tooth |
1,680 |
280 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
549 |
205 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
644 |
487 |
$19K |
| D1206 |
Topical application of fluoride varnish |
712 |
682 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
181 |
65 |
$11K |
| D9248 |
|
492 |
380 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
362 |
109 |
$4K |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$624.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
50 |
13 |
$323.82 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$163.80 |
| D1999 |
|
94 |
84 |
$0.00 |