| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,487 |
1,367 |
$49K |
| D1206 |
Topical application of fluoride varnish |
1,854 |
1,715 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,464 |
1,382 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
485 |
459 |
$25K |
| D1110 |
Prophylaxis - adult |
453 |
442 |
$19K |
| D1330 |
|
1,546 |
1,532 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
278 |
213 |
$18K |
| D0274 |
Bitewings - four radiographic images |
602 |
570 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
419 |
399 |
$10K |
| D0240 |
|
638 |
305 |
$8K |
| D0272 |
Bitewings - two radiographic images |
501 |
469 |
$8K |
| D1351 |
Sealant - per tooth |
237 |
76 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
84 |
77 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
57 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
23 |
15 |
$3K |
| D0330 |
Panoramic radiographic image |
91 |
91 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
144 |
143 |
$1K |
| D0601 |
|
12 |
12 |
$0.00 |