| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,742 |
2,696 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
3,612 |
3,549 |
$80K |
| D1206 |
Topical application of fluoride varnish |
4,090 |
4,019 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
398 |
219 |
$56K |
| D1110 |
Prophylaxis - adult |
877 |
860 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,623 |
1,586 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
611 |
597 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
166 |
72 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
618 |
609 |
$19K |
| D0240 |
|
398 |
382 |
$14K |
| D0330 |
Panoramic radiographic image |
271 |
260 |
$14K |
| D0274 |
Bitewings - four radiographic images |
400 |
388 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
123 |
123 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
182 |
177 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
153 |
146 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
27 |
$5K |
| D1351 |
Sealant - per tooth |
105 |
36 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
15 |
$178.50 |