| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,049 |
6,974 |
$217K |
| D1351 |
Sealant - per tooth |
8,114 |
1,187 |
$208K |
| D1206 |
Topical application of fluoride varnish |
5,434 |
4,823 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
3,914 |
3,655 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,162 |
2,492 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
1,714 |
1,426 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
888 |
812 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
597 |
287 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,480 |
1,324 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,908 |
1,610 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
280 |
137 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,367 |
1,908 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
356 |
160 |
$27K |
| D0330 |
Panoramic radiographic image |
382 |
354 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
319 |
292 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
53 |
15 |
$8K |
| D0350 |
|
111 |
107 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
102 |
97 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
226 |
198 |
$3K |