| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,247 |
4,247 |
$146K |
| D0120 |
Periodic oral evaluation - established patient |
5,499 |
5,499 |
$125K |
| D1351 |
Sealant - per tooth |
3,555 |
1,167 |
$105K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
999 |
702 |
$101K |
| D1110 |
Prophylaxis - adult |
2,016 |
2,016 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,250 |
6,250 |
$100K |
| D0272 |
Bitewings - two radiographic images |
5,099 |
5,099 |
$96K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
695 |
429 |
$85K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,342 |
2,302 |
$75K |
| D7111 |
|
936 |
543 |
$61K |
| D7140 |
Extraction, erupted tooth or exposed root |
729 |
442 |
$60K |
| D0330 |
Panoramic radiographic image |
949 |
949 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,546 |
3,517 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,744 |
2,434 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
305 |
227 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
371 |
371 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
210 |
209 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
42 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
34 |
29 |
$3K |
| D0274 |
Bitewings - four radiographic images |
92 |
92 |
$2K |
| D1510 |
|
13 |
12 |
$2K |
| D2331 |
|
16 |
13 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
31 |
31 |
$1K |