| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,897 |
1,887 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,932 |
1,924 |
$43K |
| D1206 |
Topical application of fluoride varnish |
2,118 |
2,111 |
$37K |
| D1351 |
Sealant - per tooth |
1,135 |
274 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,742 |
1,740 |
$25K |
| D1330 |
|
1,494 |
1,490 |
$16K |
| D1310 |
|
1,495 |
1,491 |
$16K |
| D1110 |
Prophylaxis - adult |
400 |
399 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,850 |
1,841 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
404 |
376 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,635 |
1,578 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
539 |
538 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
87 |
42 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
134 |
87 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
103 |
80 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
142 |
141 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
56 |
56 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
17 |
$918.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
15 |
$594.86 |
| D1999 |
|
15 |
15 |
$0.00 |