| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,947 |
1,935 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
1,798 |
1,788 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,946 |
1,934 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
669 |
654 |
$46K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
218 |
199 |
$25K |
| D1351 |
Sealant - per tooth |
377 |
178 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
296 |
272 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,213 |
2,192 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,358 |
2,009 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
288 |
261 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
177 |
147 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
302 |
299 |
$7K |
| D1354 |
|
254 |
156 |
$7K |
| D0274 |
Bitewings - four radiographic images |
329 |
326 |
$6K |
| D0272 |
Bitewings - two radiographic images |
513 |
509 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
224 |
221 |
$4K |
| D0330 |
Panoramic radiographic image |
144 |
140 |
$4K |