| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,929 |
3,853 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
3,440 |
3,373 |
$69K |
| D1206 |
Topical application of fluoride varnish |
3,874 |
3,798 |
$67K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
407 |
186 |
$42K |
| D1351 |
Sealant - per tooth |
1,267 |
412 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,590 |
1,566 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
225 |
162 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,649 |
1,604 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
943 |
896 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,633 |
1,246 |
$16K |
| D0330 |
Panoramic radiographic image |
300 |
292 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
482 |
474 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
207 |
159 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
224 |
119 |
$12K |
| D1110 |
Prophylaxis - adult |
131 |
130 |
$5K |
| D0274 |
Bitewings - four radiographic images |
114 |
114 |
$3K |
| D9310 |
|
52 |
52 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$388.60 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$284.90 |