| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,029 |
977 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
895 |
850 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,160 |
1,100 |
$15K |
| D0272 |
Bitewings - two radiographic images |
977 |
927 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
286 |
274 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
167 |
77 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
80 |
30 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
328 |
277 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
335 |
313 |
$3K |
| D1351 |
Sealant - per tooth |
123 |
39 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
104 |
94 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
12 |
$1K |