| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,923 |
6,782 |
$242K |
| D0120 |
Periodic oral evaluation - established patient |
8,560 |
8,415 |
$238K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,464 |
1,455 |
$201K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,729 |
976 |
$154K |
| D1206 |
Topical application of fluoride varnish |
8,474 |
8,308 |
$120K |
| D1110 |
Prophylaxis - adult |
1,904 |
1,877 |
$101K |
| D0272 |
Bitewings - two radiographic images |
3,816 |
3,733 |
$86K |
| D1351 |
Sealant - per tooth |
2,833 |
720 |
$76K |
| D9248 |
|
512 |
490 |
$59K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
338 |
160 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
441 |
339 |
$33K |
| D0274 |
Bitewings - four radiographic images |
912 |
900 |
$31K |
| D0330 |
Panoramic radiographic image |
452 |
445 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,070 |
1,003 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
786 |
747 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
121 |
55 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
305 |
288 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
198 |
196 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
79 |
72 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
139 |
125 |
$2K |
| D0270 |
|
14 |
14 |
$68.60 |
| D0603 |
|
11,416 |
11,183 |
$0.00 |