| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,184 |
5,541 |
$619K |
| D1120 |
Prophylaxis - child |
22,762 |
21,899 |
$616K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,330 |
6,267 |
$614K |
| D0120 |
Periodic oral evaluation - established patient |
30,747 |
29,642 |
$550K |
| D0330 |
Panoramic radiographic image |
12,001 |
11,412 |
$508K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
6,063 |
5,630 |
$482K |
| D1208 |
Topical application of fluoride, excluding varnish |
33,405 |
32,127 |
$470K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,471 |
4,626 |
$402K |
| D1110 |
Prophylaxis - adult |
10,652 |
10,201 |
$367K |
| D0272 |
Bitewings - two radiographic images |
19,493 |
18,784 |
$325K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,647 |
4,256 |
$310K |
| D1206 |
Topical application of fluoride varnish |
10,092 |
9,642 |
$208K |
| D0274 |
Bitewings - four radiographic images |
9,292 |
8,876 |
$203K |
| D1351 |
Sealant - per tooth |
8,914 |
2,697 |
$198K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
9,654 |
8,770 |
$154K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,864 |
5,517 |
$146K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,236 |
867 |
$107K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,416 |
962 |
$105K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
954 |
754 |
$91K |
| 92015 |
Determination of refractive state |
10,742 |
9,907 |
$86K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,291 |
3,065 |
$80K |
| D2940 |
|
1,636 |
1,150 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
1,123 |
1,048 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
441 |
338 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,086 |
1,027 |
$24K |
| D2140 |
|
305 |
209 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
30 |
25 |
$3K |
| D2394 |
|
16 |
13 |
$2K |
| D2330 |
|
24 |
19 |
$2K |
| 92250 |
|
32 |
29 |
$1K |
| D2161 |
|
15 |
12 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
34 |
30 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
30 |
30 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
42 |
38 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
111 |
91 |
$937.10 |