| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,255 |
2,938 |
$83K |
| D1120 |
Prophylaxis - child |
1,835 |
1,646 |
$62K |
| D1110 |
Prophylaxis - adult |
1,383 |
1,258 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,211 |
2,897 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
961 |
828 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,032 |
960 |
$23K |
| D0601 |
|
2,232 |
2,055 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
76 |
54 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
167 |
80 |
$9K |
| D2140 |
|
115 |
64 |
$7K |
| D0330 |
Panoramic radiographic image |
180 |
166 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
28 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$2K |
| D0602 |
|
261 |
214 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
13 |
12 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
14 |
$910.77 |
| D0220 |
Intraoral - periapical first radiographic image |
40 |
37 |
$557.60 |