| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,473 |
4,502 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
3,389 |
3,003 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,078 |
4,123 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
693 |
389 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,508 |
1,019 |
$34K |
| D0272 |
Bitewings - two radiographic images |
2,197 |
1,704 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
795 |
581 |
$22K |
| D0330 |
Panoramic radiographic image |
649 |
557 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
181 |
47 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
885 |
668 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
174 |
96 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
181 |
174 |
$10K |
| D1206 |
Topical application of fluoride varnish |
331 |
322 |
$8K |
| D0274 |
Bitewings - four radiographic images |
264 |
233 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
41 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
177 |
164 |
$2K |