| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,963 |
8,239 |
$278K |
| D1351 |
Sealant - per tooth |
8,739 |
1,154 |
$244K |
| D0120 |
Periodic oral evaluation - established patient |
9,415 |
7,785 |
$234K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,562 |
7,947 |
$151K |
| D0330 |
Panoramic radiographic image |
2,133 |
1,695 |
$103K |
| D0272 |
Bitewings - two radiographic images |
3,496 |
2,904 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
284 |
184 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
495 |
204 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
477 |
180 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,387 |
1,119 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
515 |
60 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
317 |
252 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
282 |
238 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
145 |
30 |
$2K |
| D1206 |
Topical application of fluoride varnish |
205 |
123 |
$2K |
| D1110 |
Prophylaxis - adult |
34 |
33 |
$1K |