| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,417 |
4,304 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
3,521 |
3,456 |
$105K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,687 |
2,617 |
$55K |
| D0272 |
Bitewings - two radiographic images |
1,605 |
1,570 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
323 |
189 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
652 |
615 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,585 |
1,542 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,021 |
915 |
$37K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
81 |
24 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
165 |
77 |
$14K |
| D1351 |
Sealant - per tooth |
227 |
70 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
137 |
132 |
$6K |
| D0330 |
Panoramic radiographic image |
84 |
83 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
133 |
125 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
31 |
31 |
$1K |
| D0274 |
Bitewings - four radiographic images |
14 |
12 |
$460.80 |
| D1999 |
|
13 |
13 |
$0.00 |