| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,652 |
1,563 |
$306.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,522 |
1,435 |
$198.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
441 |
287 |
$192.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
299 |
283 |
$145.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,276 |
1,218 |
$135.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,818 |
1,700 |
$100.00 |
| D1110 |
Prophylaxis - adult |
221 |
212 |
$84.00 |
| D0272 |
Bitewings - two radiographic images |
1,043 |
986 |
$70.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,745 |
1,453 |
$70.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
153 |
113 |
$56.00 |
| D0210 |
Intraoral - complete series of radiographic images |
180 |
177 |
$47.00 |
| D0274 |
Bitewings - four radiographic images |
368 |
335 |
$44.00 |
| D0240 |
|
204 |
54 |
$34.00 |
| D1206 |
Topical application of fluoride varnish |
662 |
616 |
$30.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
296 |
284 |
$28.00 |
| D9248 |
|
141 |
135 |
$27.00 |
| D0601 |
|
87 |
84 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
12 |
$0.00 |
| D1351 |
Sealant - per tooth |
306 |
114 |
$0.00 |
| D0603 |
|
14 |
13 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$0.00 |
| D0330 |
Panoramic radiographic image |
90 |
86 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
96 |
95 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
48 |
40 |
$0.00 |
| D1999 |
|
162 |
141 |
$0.00 |