| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,118 |
7,085 |
$206K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,719 |
1,327 |
$202K |
| D0120 |
Periodic oral evaluation - established patient |
8,069 |
8,027 |
$139K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,637 |
7,599 |
$135K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
712 |
388 |
$103K |
| D1110 |
Prophylaxis - adult |
2,422 |
2,408 |
$95K |
| D1351 |
Sealant - per tooth |
2,856 |
898 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
866 |
555 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,333 |
2,178 |
$69K |
| D9994 |
|
8,735 |
8,687 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
834 |
522 |
$60K |
| D0330 |
Panoramic radiographic image |
767 |
758 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,906 |
3,987 |
$46K |
| D0272 |
Bitewings - two radiographic images |
2,625 |
2,613 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
4,519 |
4,468 |
$42K |
| D1206 |
Topical application of fluoride varnish |
1,803 |
1,795 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
265 |
206 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,316 |
1,309 |
$29K |
| D1354 |
|
2,109 |
559 |
$25K |
| D9920 |
|
310 |
278 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
910 |
905 |
$22K |
| D8670 |
Periodic orthodontic treatment visit |
40 |
40 |
$21K |
| D3120 |
|
780 |
469 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
449 |
434 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
461 |
461 |
$11K |
| D0240 |
|
555 |
296 |
$8K |
| D2332 |
|
40 |
29 |
$6K |
| D0340 |
|
34 |
34 |
$3K |
| D2330 |
|
19 |
12 |
$2K |
| D0603 |
|
45 |
45 |
$450.00 |