| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
572 |
548 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
165 |
99 |
$19K |
| D1206 |
Topical application of fluoride varnish |
500 |
484 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
282 |
263 |
$10K |
| D1110 |
Prophylaxis - adult |
183 |
167 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
333 |
328 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
284 |
234 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
68 |
41 |
$6K |
| D0272 |
Bitewings - two radiographic images |
192 |
181 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
25 |
12 |
$4K |
| D1351 |
Sealant - per tooth |
115 |
40 |
$4K |
| D0330 |
Panoramic radiographic image |
46 |
44 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
27 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$238.20 |