| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,219 |
2,179 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,451 |
1,417 |
$85K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
743 |
487 |
$75K |
| D1351 |
Sealant - per tooth |
1,907 |
576 |
$69K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
358 |
244 |
$65K |
| D1206 |
Topical application of fluoride varnish |
2,126 |
2,090 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
835 |
699 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
363 |
239 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
325 |
225 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
709 |
705 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
527 |
503 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,341 |
1,036 |
$21K |
| D0274 |
Bitewings - four radiographic images |
488 |
475 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,168 |
1,129 |
$20K |
| D0272 |
Bitewings - two radiographic images |
611 |
591 |
$17K |
| D0330 |
Panoramic radiographic image |
238 |
237 |
$17K |
| D3120 |
|
14 |
13 |
$0.00 |
| D0603 |
|
13 |
13 |
$0.00 |