| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,945 |
2,931 |
$118K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
746 |
221 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
1,992 |
1,983 |
$56K |
| D1206 |
Topical application of fluoride varnish |
2,944 |
2,930 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
432 |
263 |
$30K |
| D1351 |
Sealant - per tooth |
817 |
270 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
611 |
606 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,191 |
1,186 |
$19K |
| D0603 |
|
2,778 |
2,758 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,065 |
627 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
545 |
527 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
244 |
155 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
218 |
218 |
$13K |
| D0240 |
|
786 |
488 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
907 |
883 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
144 |
73 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
320 |
319 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
104 |
104 |
$4K |
| D0330 |
Panoramic radiographic image |
268 |
267 |
$2K |
| D1354 |
|
563 |
203 |
$2K |
| D0274 |
Bitewings - four radiographic images |
41 |
41 |
$903.35 |
| D0602 |
|
83 |
83 |
$565.95 |
| D0601 |
|
12 |
12 |
$77.00 |
| D1330 |
|
2,432 |
2,426 |
$0.16 |
| D1310 |
|
2,430 |
2,424 |
$0.09 |