| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,019 |
1,945 |
$54K |
| D1206 |
Topical application of fluoride varnish |
2,210 |
2,122 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,753 |
1,692 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
517 |
489 |
$13K |
| D0272 |
Bitewings - two radiographic images |
653 |
623 |
$11K |
| D0330 |
Panoramic radiographic image |
217 |
203 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
112 |
69 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
62 |
25 |
$7K |
| D1110 |
Prophylaxis - adult |
197 |
190 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
362 |
341 |
$7K |
| D1351 |
Sealant - per tooth |
306 |
53 |
$7K |
| D0274 |
Bitewings - four radiographic images |
158 |
146 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
85 |
83 |
$1K |
| D0240 |
|
25 |
16 |
$405.04 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$392.27 |