| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,923 |
3,601 |
$134K |
| D0210 |
Intraoral - complete series of radiographic images |
2,595 |
2,037 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,363 |
2,626 |
$128K |
| D1110 |
Prophylaxis - adult |
2,207 |
1,668 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
972 |
442 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,273 |
510 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,485 |
2,142 |
$64K |
| D1206 |
Topical application of fluoride varnish |
2,516 |
2,296 |
$60K |
| D1351 |
Sealant - per tooth |
1,844 |
509 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,925 |
1,780 |
$38K |
| D0145 |
Oral evaluation for a patient under three years of age |
784 |
728 |
$34K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
258 |
78 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
911 |
802 |
$34K |
| D0330 |
Panoramic radiographic image |
345 |
294 |
$17K |
| D0272 |
Bitewings - two radiographic images |
657 |
567 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
723 |
639 |
$9K |
| D9920 |
|
104 |
61 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
36 |
16 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
119 |
68 |
$1K |