| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,928 |
6,840 |
$231K |
| D0120 |
Periodic oral evaluation - established patient |
7,518 |
7,450 |
$203K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,826 |
6,760 |
$136K |
| D1110 |
Prophylaxis - adult |
1,425 |
1,417 |
$70K |
| D0272 |
Bitewings - two radiographic images |
3,043 |
2,956 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,425 |
1,325 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
467 |
270 |
$33K |
| D1351 |
Sealant - per tooth |
988 |
339 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,022 |
1,008 |
$24K |
| D0145 |
Oral evaluation for a patient under three years of age |
481 |
480 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,239 |
1,088 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
219 |
145 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
108 |
24 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
547 |
440 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
934 |
442 |
$6K |
| D7960 |
|
26 |
15 |
$5K |
| D1999 |
|
40 |
32 |
$100.00 |