| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,448 |
13,305 |
$496K |
| D0120 |
Periodic oral evaluation - established patient |
13,474 |
13,311 |
$387K |
| D1206 |
Topical application of fluoride varnish |
8,335 |
8,247 |
$225K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,281 |
7,204 |
$145K |
| D1110 |
Prophylaxis - adult |
2,552 |
2,507 |
$130K |
| D0272 |
Bitewings - two radiographic images |
5,496 |
5,431 |
$123K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,811 |
2,602 |
$107K |
| D0330 |
Panoramic radiographic image |
1,379 |
1,366 |
$81K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
542 |
171 |
$75K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,306 |
1,298 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
667 |
453 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
3,259 |
3,184 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,584 |
1,170 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
271 |
190 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
363 |
355 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
182 |
93 |
$17K |
| D1351 |
Sealant - per tooth |
229 |
67 |
$7K |
| D9986 |
|
33 |
33 |
$0.00 |