| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,051 |
10,050 |
$505K |
| D0120 |
Periodic oral evaluation - established patient |
3,983 |
3,983 |
$283K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,029 |
4,029 |
$268K |
| D1310 |
|
4,422 |
4,421 |
$200K |
| D1206 |
Topical application of fluoride varnish |
9,825 |
9,823 |
$186K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,193 |
8,081 |
$139K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,079 |
1,457 |
$133K |
| D1351 |
Sealant - per tooth |
3,183 |
1,077 |
$119K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,916 |
1,765 |
$76K |
| D0274 |
Bitewings - four radiographic images |
2,549 |
2,549 |
$54K |
| D0272 |
Bitewings - two radiographic images |
4,398 |
4,398 |
$51K |
| D0603 |
|
3,426 |
3,425 |
$50K |
| D0145 |
Oral evaluation for a patient under three years of age |
567 |
567 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
423 |
321 |
$32K |
| D0350 |
|
3,192 |
2,463 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
552 |
434 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
443 |
376 |
$23K |
| D9430 |
|
721 |
701 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,381 |
1,363 |
$16K |
| D0601 |
|
926 |
926 |
$13K |
| D0330 |
Panoramic radiographic image |
189 |
189 |
$5K |